Cancer Pathology Data Sharing
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This page is part of the Sharing eCC Data from Pathology Labs to EHR (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 1.0.1. For a full list of available versions, see the Directory of published versions

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Document Details

Generated Narrative: Bundle INVASIVE CARCINOMA OF THE BREAST: Resection


Document Subject

Generated Narrative: Patient patient-OakleyAnnie

Annie Oakley Female, DoB: 1990-06-01 ( SHID: 12446 (use: usual, ))


Other Ids:
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Document Content

INVASIVE CARCINOMA OF THE BREAST: Resection

Specimen

Procedure

Needle biopsy
__ Fine needle aspiration
__ Other (specify): ___________________
__ Not specified

Specimen Laterality

__ Right
Left
__ Not specified

+Tumor Site (select all that apply)

__ Upper outer quadrant
__ Lower outer quadrant
__ Upper inner quadrant
__ Lower inner quadrant
__ Central
__ Nipple
Clock position

Specify Clock Position (select all that apply)

__ 1 o'clock
__ 2 o'clock
__ 3 o'clock
__ 4 o'clock
__ 5 o'clock
__ 6 o'clock
__ 7 o'clock
8 o'clock
__ 9 o'clock
__ 10 o'clock
__ 11 o'clock
__ 12 o'clock

__ Specify distance from nipple in Centimeters (cm): _______________ cm
__ Other (specify): ___________________
__ Not specified

Histologic Type (Note A)

__ No residual invasive carcinoma
Invasive carcinoma of no special type (ductal)
__ Micro-invasive carcinoma
__ Invasive lobular carcinoma
__ Invasive carcinoma with mixed ductal and lobular features
__ Invasive carcinoma with features of (specify): ___________________
__ Tubular carcinoma
__ Invasive cribriform carcinoma
__ Mucinous carcinoma
__ Invasive micropapillary carcinoma
__ Apocrine adenocarcinoma
__ Metaplastic carcinoma
__ Encapsulated papillary carcinoma with invasion
__ Solid papillary carcinoma with invasion
__ Intraductal papillary adenocarcinoma with invasion
__ Adenoid cystic carcinoma
__ Neuroendocrine tumor
__ Neuroendocrine carcinoma
__ Invasive carcinoma, type cannot be determined: ___________________
__ Other histologic type not listed (specify): ___________________
__ Histologic Type Comment: ___________________

Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note B)

__ Not applicable (no residual carcinoma or microinvasion only)
Nottingham Score

Glandular (Acinar) / Tubular Differentiation

Score 1 (greater than 75% of tumor area forming glandular / tubular structures)
__ Score 2 (10% to 75% of tumor area forming glandular / tubular structures)
__ Score 3 (less than 10% of tumor area forming glandular / tubular structures)
__ Score cannot be determined

Nuclear Pleomorphism

__ Score 1 (Nuclei small with little increase in size in comparison with normal breast epithelial cells, regular outlines, uniform nuclear chromatin, little variation in size)
Score 2 (Cells larger than normal with open vesicular nuclei, visible nucleoli, and moderate variability in both size and shape)
__ Score 3 (Vesicular nuclei, often with prominent nucleoli, exhibiting marked variation in size and shape, occasionally with very large and bizarre forms)
__ Score cannot be determined

Mitotic Rate

See Table 1 in CAP Protocol
Score 1
__ Score 2
__ Score 3
__ Score cannot be determined: ___________________

Overall Grade

Grade 1 (scores of 3, 4, or 5)

Tumor Size (Note E)

__ No residual invasive carcinoma
__ Microinvasion only (less than or equal to 1 mm)
Greatest dimension of largest invasive focus greater than 1 mm (specify exact measurement in Millimeters (mm)): 13.0 mm
__ Additional Dimension in Millimeters (mm): ____ × ____ mm
__ Size of largest invasive focus cannot be determined (explain): ___________________

+Tumor Focality (Note F)

Single focus of invasive carcinoma
__ Multiple foci of invasive carcinoma
__ Number of Foci
__ Specify number: ___________________
__ At least: ___________________
__ Cannot be determined

Ductal Carcinoma In Situ (DCIS) (Note G)

Not identified
__ Present
__ Present (in close proximity to invasive carcinoma)
__ Present only after presurgical therapy and prior to therapy the cancer is classified as pTis
__ Negative for extensive intraductal component (EIC)
__ Positive for extensive intraductal component (EIC)
__ Only DCIS is present after presurgical (neoadjuvant) therapy

+Size (Extent) of DCIS

__ Estimated size (extent) of DCIS is at least in Millimeters (mm): _____ mm
__ Additional Dimension in Millimeters (mm): _____ × _____ mm
__ Cannot be determined

Tumor Extent (Note H)

__ Tumor Extent (required only if skin, nipple, or skeletal muscle are present and involved) (select all that apply)
Not applicable (skin, nipple, and skeletal muscle are absent OR are uninvolved)

Margin Status for Invasive Carcinoma (required only if residual invasive carcinoma is present in specimen)

__ Not applicable (residual invasive carcinoma in specimen is absent)
All margins negative for invasive carcinoma

Distance from Invasive Carcinoma to Closest Margin

Specify in Millimeters (mm):

Exact distance: ______________ mm
__ Less than: ______________ mm
__ Greater than: ______________ mm
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

+Closest Margin(s) to Invasive Carcinoma (select all that apply)

__ Anterior
__ Posterior
__ Superior
__ Inferior
__ Medial
Lateral
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Margin(s) Involved by Invasive Carcinoma (select all that apply)

__ Anterior (specify extent): ______________
__ Posterior (specify extent): ______________
__ Superior (specify extent): ______________
__ Inferior (specify extent): ______________
__ Medial (specify extent): ______________
__ Lateral (specify extent): ______________
__ Other (specify margin(s) and extent): ______________
__ Cannot be determined (explain): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Regional Lymph Node Status

__ Not applicable (no regional lymph nodes submitted or found)
Regional lymph nodes present
__ All regional lymph nodes negative for tumor
__ Tumor present in regional lymph node(s)

Number of Lymph Nodes with Macrometastases (greater than 2 mm)

__ Exact number (specify): ______________
__ At least (specify): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Number of Lymph Nodes with Micrometastases (greater than 0.2 mm to 2 mm and / or greater than 200 cells)

__ Exact number (specify): ______________
__ At least (specify): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Number of Lymph Nodes with Isolated Tumor Cells (0.2 mm or less OR 200 cells or less) (required only if applicable)

__ Not applicable
__ Exact number (specify): ______________
__ At least (specify): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Size of Largest Nodal Metastatic Deposit

Specify in Millimeters (mm):

__ Exact size: ______________ mm
__ Less than: ______________ mm
__ Greater than: ______________ mm
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Extranodal Extension

__ Not identified
__ Present, 2 mm or less
__ Present, greater than 2 mm

+Specify Amount:

__ Present
__ Cannot be determined: ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Total Number of Lymph Nodes Examined (sentinel and non-sentinel)

Exact number (specify): ______________
__ At least (specify): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Number of Sentinel Nodes Examined (if applicable)

__ Not applicable
Exact number (specify): ______________
__ At least (specify): ______________
__ Other (specify): ______________
__ Cannot be determined (explain): ______________

Distant Site(s) Involved, if applicable (select all that apply)

Not applicable
__ Non-regional lymph node(s) (specify, if possible): ______________
__ Lung: ______________
__ Liver: ______________
__ Bone: ______________
__ Brain: ______________
__ Other (specify): ______________
__ Cannot be determined

Modified Classification (required only if applicable) (select all that apply)

__ Not applicable
__ y (post-neoadjuvant therapy)
__ r (recurrence)

pT Category

__ pT not assigned (cannot be determined based on available pathological information)
__ pT0: No evidence of primary tumor
__ pTis (DCIS): Ductal carcinoma in situ
__ pTis (Paget): Paget disease NOT associated with invasive carcinoma and / or carcinoma in situ (DCIS) in the underlying breast parenchyma
__ pT1: Tumor less than or equal to 20 mm in greatest dimension
__ pT1mi: Tumor less than or equal to 1 mm in greatest dimension
__ pT1a: Tumor greater than 1 mm but less than or equal to 5 mm in greatest dimension
pT1b: Tumor greater than 5 mm but less than or equal to 10 mm in greatest dimension
__ pT1c: Tumor greater than 10 mm but less than or equal to 20 mm in greatest dimension
__ pT2: Tumor greater than 20 mm but less than or equal to 50 mm in greatest dimension
__ pT3: Tumor greater than 50 mm in greatest dimension
__ pT4: Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules)
__ pT4a: Extension to the chest wall; invasion of or adherence to pectoralis muscle in the absence of invasion of chest wall structures does not qualify as T4
__ pT4b: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d'orange) of the skin which do not meet the criteria for inflammatory carcinoma
__ pT4c: Both T4a and T4b are present
__ pT4d: Inflammatory carcinoma
__ pT4 (subcategory cannot be determined)

pN Category

__ pN not assigned (no nodes submitted or found)
__ pN not assigned (cannot be determined based on available pathological information)
pN0: No regional lymph node metastasis identified or ITCs only
__ pN0 (i+): ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s)
__ pN0 (mol+): Positive molecular findings by reverse transcriptase polymerase chain reaction (RT-PCR); no ITCs detected
__ pN1: Metastases in 1 to 3 axillary lymph nodes, at least one metastasis larger than 2.0 mm
__ pN1mi: Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger than 2.0 mm)
__ pN1a: Metastases in 1 to 3 axillary lymph nodes, at least one metastasis larger than 2.0 mm
__ pN1b: Metastases in internal mammary sentinel nodes, excluding ITCs
__ pN1c: pN1a and pN1b combined
__ pN2: Metastases in 4-9 axillary lymph nodes; or in clinically detected internal mammary lymph nodes with negative axillary nodes
__ pN2a: Metastases in 4-9 axillary lymph nodes (at least one tumor deposit larger than 2.0 mm)
__ pN2b: Metastases in clinically detected internal mammary lymph nodes with or without microscopic confirmation; with pathologically negative axillary lymph nodes
__ pN3: Metastases in 10 or more axillary lymph nodes; or in infraclavicular (level III axillary) lymph nodes; or in clinically detected ipsilateral internal mammary lymph nodes with one or more positive level I, II axillary lymph nodes; or in more than 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease or macroscopic disease detected by sentinel lymph node biopsy but not clinically detected; or in ipsilateral supraclavicular lymph nodes
__ pN3a: Metastases in 10 or more axillary lymph nodes (at least one tumor deposit larger than 2.0 mm); or metastases to the infraclavicular (level III axillary lymph) nodes
__ pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging); or pN2a in the presence of pN1b
__ pN3c: Metastases in ipsilateral supraclavicular lymph nodes

N Suffix (required only if applicable)

__ Not applicable
__ (sn) Sentinel node(s) evaluated. If 6 or more nodes (sentinel or nonsentinel) are removed, this modifier should not be used
__ (f) Nodal metastasis confirmed by fine needle aspiration or core needle biopsy
__ (m) Multiple primary synchronous tumors in a single organ

ADDITIONAL FINDINGS (Note O)

+Additional Findings (specify): ________________

SPECIAL STUDIES

The CAP Breast Biomarker Template should be used for reporting biomarkers requested for this resection specimen. Pending biomarker studies should be listed in the Comments section of this report.

+Breast Biomarker Studies Performed on Previous Biopsy (select all that apply)

Estrogen Receptor (ER)

Estrogen Receptor (ER) Status

__ Positive (greater than 10% of cells demonstrate nuclear positivity)
__ Low Positive (1-10% of cells with nuclear positivity)
__ Negative
Cannot be determined (indeterminate)

__ Progesterone Receptor (PgR)

HER2 (by immunohistochemistry)

Negative (Score 0)
__ Negative (Score 1+)
__ Equivocal (Score 2+)
__ Positive (Score 3+)
__ Cannot be determined (indeterminate)

__ HER2 (by in situ hybridization)


Additional Resources Included in Document


Entry 1 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Composition/composition-invasive-carcinoma-of-the-breast

Resource Composition:

Generated Narrative: Composition composition-invasive-carcinoma-of-the-breast

Document DiagnosticReport Reference: Diagnostic Report for 'Pathology Synoptic report' for '->Annie Oakley'

status: Final

type: INVASIVE CARCINOMA OF THE BREAST: Biopsy

encounter: Bundle: identifier = UUID:1e518c9a-b9a2-4ee6-a350-8965b7924311; type = document; timestamp = 2024-12-05 18:05:57+0000

date: 2025-01-01 21:39:30+0000

author: Wise Owl

title: INVASIVE CARCINOMA OF THE BREAST: Resection


Entry 2 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/DiagnosticReport/diagnosticreport-breast-invasive-carcinoma

Resource DiagnosticReport:

Generated Narrative: DiagnosticReport diagnosticreport-breast-invasive-carcinoma

Pathology Synoptic report (Pathology)

SubjectAnnie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))
When For2025-03-18 21:39:30+0000
Performer PractitionerRole Primary Interpreter
Identifier https://cap.org/eCC/urn:uuid:7c9139fe-ddd5-49d9-b649-f37344e8b995

Report Details

CodeValueFlagsWhen For
SPECIMENFinal2025-03-18
TUMORFinal2024-12-05
Tumor Extent (Note H)Final2025-03-18 14:52:02+0000 --> (ongoing)
Lymph NodesFinal2025-03-18
MARGINS (Note L)Final2025-03-18
REGIONAL LYMPH NODES (Note M)Final2025-03-18
Distant MetastasisFinal2025-03-18
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note M)Final2025-03-18
ADDITIONAL FINDINGS (Note N)Final2025-03-18
SPECIAL STUDIESFinal2025-03-18
COMMENTSFinal2025-03-18

Entry 3 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-specimen

Resource Observation:

Generated Narrative: Observation observation-section-specimen

identifier: https://cap.org/eCC/urn:uuid:6ac70450-cc74-4a8e-8699-9ffab1e0ac24

status: Final

category: Section

code: SPECIMEN

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember:


Entry 4 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-tumor

Resource Observation:

Generated Narrative: Observation observation-section-tumor

identifier: https://cap.org/eCC/urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85

status: Final

category: Section

code: TUMOR

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2024-12-05

performer: Practitioner Wise Owl

hasMember:


Entry 5 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-lymph-nodes

Resource Observation:

Generated Narrative: Observation observation-section-lymph-nodes

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Section

code: Lymph Nodes

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl


Entry 6 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-margins

Resource Observation:

Generated Narrative: Observation observation-section-margins

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Section

code: MARGINS (Note L)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation Margin Status for Invasive Carcinoma


Entry 7 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-regional-lymph-nodes

Resource Observation:

Generated Narrative: Observation observation-section-regional-lymph-nodes

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Section

code: REGIONAL LYMPH NODES (Note M)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation Regional Lymph Node Status


Entry 8 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-distant-metastasis

Resource Observation:

Generated Narrative: Observation observation-section-distant-metastasis

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Section

code: Distant Metastasis

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation DISTANT METASTASIS


Entry 9 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-ptnm-classification

Resource Observation:

Generated Narrative: Observation observation-section-ptnm-classification

identifier: https://cap.org/eCC/urn:uuid:4958b036-f88e-470b-b225-38e9fe6b6541

status: Final

category: Section

code: PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note M)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember:


Entry 10 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-additional-findings

Resource Observation:

Generated Narrative: Observation observation-section-additional-findings

identifier: https://cap.org/eCC/urn:uuid:7c9139fe-ddd5-49d9-b649-f37344e8b995

status: Final

category: Section

code: ADDITIONAL FINDINGS (Note N)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation Additional Findings (specify)


Entry 11 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-additional-findings-specify

Resource Observation:

Generated Narrative: Observation observation-additional-findings-specify

identifier: https://cap.org/eCC/urn:uuid:9cfaa1f6-f0af-4e66-8fe0-130b2143b135

status: Final

category: Question

code: Additional Findings (specify)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

derivedFrom: Observation ADDITIONAL FINDINGS (Note N)


Entry 12 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-special-studies

Resource Observation:

Generated Narrative: Observation observation-section-special-studies

identifier: https://cap.org/eCC/urn:uuid:87335ed1-f468-4061-a401-8b8e3b54cf4c

status: Final

category: Section

code: SPECIAL STUDIES

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation Breast Biomarker Testing Performed on Previous Biopsy


Entry 13 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-comments

Resource Observation:

Generated Narrative: Observation observation-section-comments

identifier: https://cap.org/eCC/uuid:c3189cd4-33a0-447f-9bbf-2b225e2aa305

status: Final

category: Section

code: COMMENTS

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl


Entry 14 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-procedure-breast-excision

Resource Observation:

Generated Narrative: Observation observation-procedure-breast-excision

identifier: https://cap.org/eCC/urn:uuid:7c9139fe-ddd5-49d9-b649-f37344e8b995

status: Final

category: Question

code: Procedure (Note A)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Excision (less than total mastectomy)

derivedFrom: Observation SPECIMEN


Entry 15 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-specimen-laterality

Resource Observation:

Generated Narrative: Observation observation-specimen-laterality

identifier: https://cap.org/eCC/urn:uuid:4bcd147c-ff3d-4eb3-bcd3-9d679bd1ad1b

status: Final

category: Question

code: Specimen Laterality

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Right

derivedFrom: Observation SPECIMEN


Entry 16 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-tumor-site

Resource Observation:

Generated Narrative: Observation observation-tumor-site

identifier: https://cap.org/eCC/urn:uuid:79ab15c8-4b0e-48e5-a477-7f72e62c002b

status: Final

category: Question

code: Tumor Site (Note B)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

hasMember: Observation Clock position

derivedFrom: Observation TUMOR


Entry 17 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-clock-position

Resource Observation:

Generated Narrative: Observation observation-clock-position

identifier: https://cap.org/eCC/urn:uuid:ab9326c2-e1fe-4ba0-873c-41c923c7f772

status: Final

category: Question

code: Clock position

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Clock position

hasMember: Observation Specify Clock Position

derivedFrom: Observation Tumor Site (Note B)


Entry 18 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-clock-position-8

Resource Observation:

Generated Narrative: Observation observation-clock-position-8

identifier: https://cap.org/eCC/urn:uuid:bf778f95-b1a8-4674-a73e-1f2dc0bfbdc4

status: Final

category: Question

code: Specify Clock Position

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-13 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: 8 o'clock


Entry 19 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-histologic-type

Resource Observation:

Generated Narrative: Observation observation-histologic-type

identifier: https://cap.org/eCC/urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85

status: Final

category: Question

code: Histologic Type (Note C)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Invasive carcinoma of no special type (ductal)


Entry 20 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-histologic-grade

Resource Observation:

Generated Narrative: Observation observation-histologic-grade

identifier: https://cap.org/eCC/urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85

status: Final

category: Question

code: ?Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note D)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Nottingham Score

hasMember:

derivedFrom: Observation TUMOR


Entry 21 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-glandular-differentiation

Resource Observation:

Generated Narrative: Observation observation-glandular-differentiation

identifier: https://cap.org/eCC/urn:uuid:f0d0b23b-f6a0-44d4-bfaf-ade1b485c0b0

status: Final

category: Question

code: Glandular (Acinar) / Tubular Differentiation

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Score 2 (10 to 75% of tumor area forming glandular / tubular structures)

derivedFrom: Observation ?Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note D)


Entry 22 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-nuclear-pleomorphism

Resource Observation:

Generated Narrative: Observation observation-nuclear-pleomorphism

identifier: https://cap.org/eCC/urn:uuid:77d0563d-3685-4316-9a81-fa7d04d0d8d2

status: Final

category: Question

code: Nuclear Pleomorphism

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Score 2 (Cells larger than normal with open vesicular nuclei, visible nucleoli, and moderate variability in both size and shape)

derivedFrom: Observation ?Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note D)


Entry 23 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-mitotic-rate

Resource Observation:

Generated Narrative: Observation observation-mitotic-rate

identifier: https://cap.org/eCC/urn:uuid:814dd523-9284-4edb-8831-fc1c440e4979

status: Final

category: Question

code: Mitotic Rate

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Score 1

derivedFrom: Observation ?Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note D)


Entry 24 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-overall-grade

Resource Observation:

Generated Narrative: Observation observation-overall-grade

identifier: https://cap.org/eCC/urn:uuid:ddea4bbc-a3e7-477b-b279-57cf5071e0b9

status: Final

category: Question

code: Overall Grade

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2024-12-05 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Grade 1 (scores of 3, 4 or 5)

derivedFrom: Observation ?Histologic Grade (Nottingham Histologic Score) (required only if applicable) (Note D)


Entry 25 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-tumor-size

Resource Observation:

Generated Narrative: Observation observation-tumor-size

identifier: https://cap.org/eCC/urn:uuid:66153175-f304-443e-99cb-4058f350248b

status: Final

category: Question

code: Tumor Size (Note E)

subject: Annie Oakley

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: PractitionerRole Primary Interpreter

value: Greatest dimension of largest invasive focus greater than 1 mm (specify exact measurement in Millimeters (mm))

hasMember: Observation Additional Dimension in Millimeters (mm)

derivedFrom: Observation TUMOR


Entry 26 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-additional-dimension

Resource Observation:

Generated Narrative: Observation observation-additional-dimension

identifier: https://cap.org/eCC/urn:uuid:18c9ea9c-ddf2-400d-adea-07c97dd7b016

status: Final

category: Question

code: Additional Dimension in Millimeters (mm)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: 13

derivedFrom: Observation Tumor Size (Note E)


Entry 27 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-tumor-focality

Resource Observation:

Generated Narrative: Observation observation-tumor-focality

identifier: https://cap.org/eCC/urn:uuid:309f8a1c-8311-4751-8718-4b2573a09633

status: Final

category: Question

code: Tumor Focality (Note F)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Single focus of invasive carcinoma

derivedFrom: Observation TUMOR


Entry 28 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-ductal-carcinoma

Resource Observation:

Generated Narrative: Observation observation-ductal-carcinoma

identifier: https://cap.org/eCC/urn:uuid:c2f916f9-7438-4ba6-9cba-9e9064edbe3c

status: Final

category: Question

code: Ductal Carcinoma In Situ (DCIS) (Note G)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Not identified

derivedFrom: Observation TUMOR


Entry 29 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-section-tumor-extent

Resource Observation:

Generated Narrative: Observation observation-section-tumor-extent

identifier: https://cap.org/eCC/urn:uuid:1dc64a64-e4f1-4996-87df-28b76446c35a

status: Final

category: Section

code: Tumor Extent (Note H)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

derivedFrom: Observation TUMOR


Entry 30 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-margins-margin-status-for-invasive-carcinoma

Resource Observation:

Generated Narrative: Observation observation-margins-margin-status-for-invasive-carcinoma

identifier: https://cap.org/eCC/urn:uuid:ee170d9a-d5b5-481a-ac58-52dea11955b4

status: Final

category: Question

code: Margin Status for Invasive Carcinoma

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: All margins negative for invasive carcinoma

hasMember:

derivedFrom: Observation MARGINS (Note L)


Entry 31 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-margins-distance-to-closest-margin

Resource Observation:

Generated Narrative: Observation observation-margins-distance-to-closest-margin

identifier: https://cap.org/eCC/urn:uuid:7069b59e-9414-4838-bd6d-674ef97c414c

status: Final

category: Question

code: Distance from Invasive Carcinoma to Closest Margin

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Exact distance

derivedFrom: Observation Margin Status for Invasive Carcinoma


Entry 32 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-margins-closest-margin-to-invasive-carcinoma

Resource Observation:

Generated Narrative: Observation observation-margins-closest-margin-to-invasive-carcinoma

identifier: https://cap.org/eCC/urn:uuid:c12982a8-541c-469a-b016-9468d58eb858

status: Final

category: Question

code: Closest Margin(s) to Invasive Carcinoma

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18 14:52:02+0000 --> (ongoing)

performer: Practitioner Wise Owl

value: Lateral

derivedFrom: Observation MARGINS (Note L)


Entry 33 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-regional-lymph-node-status

Resource Observation:

Generated Narrative: Observation observation-regional-lymph-node-status

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Question

code: Regional Lymph Node Status

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Regional lymph nodes present

hasMember:

derivedFrom: Observation REGIONAL LYMPH NODES (Note M)


Entry 34 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-regional-lymph-nodes-number-examined

Resource Observation:

Generated Narrative: Observation observation-regional-lymph-nodes-number-examined

identifier: https://cap.org/eCC/urn:uuid:a903ae85-913a-4c9b-94cb-c6a1e00340e3

status: Final

category: Question

code: Total Number of Lymph Nodes Examined (sentinel and non-sentinel)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Exact number (specify)

derivedFrom: Observation Regional Lymph Node Status


Entry 35 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-regional-lymph-nodes-number-sentinel

Resource Observation:

Generated Narrative: Observation observation-regional-lymph-nodes-number-sentinel

identifier: https://cap.org/eCC/urn:uuid:25b43d87-bad0-4779-91c8-352ad2f778ce

status: Final

category: Question

code: Number of Sentinel Nodes Examined

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Exact number (specify)

derivedFrom: Observation Regional Lymph Node Status


Entry 36 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-distant-metastasis

Resource Observation:

Generated Narrative: Observation observation-distant-metastasis

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Section

code: DISTANT METASTASIS

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember: Observation ?Distant Site(s) Involved, if applicable


Entry 37 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-distant-metastasis-distant-sites

Resource Observation:

Generated Narrative: Observation observation-distant-metastasis-distant-sites

identifier: https://cap.org/eCC/urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

status: Final

category: Question

code: ?Distant Site(s) Involved, if applicable

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: ?Not applicable

derivedFrom: Observation DISTANT METASTASIS


Entry 38 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-ptnm-classification-pT-Category

Resource Observation:

Generated Narrative: Observation observation-ptnm-classification-pT-Category

identifier: https://cap.org/eCC/urn:uuid:4958b036-f88e-470b-b225-38e9fe6b6541

status: Final

category: Question

code: pT Category

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: pT1b: Tumor greater than 5 mm but less than or equal to 10 mm in greatest dimension

derivedFrom: Observation PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note M)


Entry 39 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-ptnm-classification-pN-Category

Resource Observation:

Generated Narrative: Observation observation-ptnm-classification-pN-Category

identifier: https://cap.org/eCC/urn:uuid:7164b3a9-3061-4f7f-9bbb-2a4e6980d665

status: Final

category: Question

code: pN Category

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: pN0: No regional lymph node metastasis identified or ITCs only#

derivedFrom: Observation PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note M)


Entry 40 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-special-studies-breast-biomarker

Resource Observation:

Generated Narrative: Observation observation-special-studies-breast-biomarker

identifier: https://cap.org/eCC/urn:uuid:3a313831-c8c5-44e7-8df2-af1b47b9879f

status: Final

category: Question

code: Breast Biomarker Testing Performed on Previous Biopsy

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

hasMember:

derivedFrom: Observation SPECIAL STUDIES


Entry 41 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-special-studies-estrogen-receptor

Resource Observation:

Generated Narrative: Observation observation-special-studies-estrogen-receptor

identifier: https://cap.org/eCC/urn:uuid:8e615e45-6a49-46d9-8dfe-e84f19c29a92

status: Final

category: Question

code: Estrogen Receptor (ER)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-05

performer: Practitioner Wise Owl

value: Estrogen Receptor (ER)

hasMember: Observation Estrogen Receptor (ER) Status

derivedFrom: Observation Breast Biomarker Testing Performed on Previous Biopsy


Entry 42 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-special-studies-estrogen-receptor-status

Resource Observation:

Generated Narrative: Observation observation-special-studies-estrogen-receptor-status

identifier: https://cap.org/eCC/urn:uuid:32bd9a78-878b-4fda-a6bd-c0bc58109fe7

status: Final

category: Question

code: Estrogen Receptor (ER) Status

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Cannot be determined (indeterminate)

derivedFrom: Observation Estrogen Receptor (ER)


Entry 43 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-special-studies-her2

Resource Observation:

Generated Narrative: Observation observation-special-studies-her2

identifier: https://cap.org/eCC/urn:uuid:deacb965-18d3-4451-a27f-0e26e7a9e5a2

status: Final

category: Question

code: HER2 (by immunohistochemistry)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Stains Alot

hasMember: Observation HER2 (by immunohistochemistry)

derivedFrom: Observation Breast Biomarker Testing Performed on Previous Biopsy


Entry 44 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Observation/observation-special-studies-negative

Resource Observation:

Generated Narrative: Observation observation-special-studies-negative

identifier: https://cap.org/eCC/urn:uuid:1ca2fb51-1752-4489-a4b0-5c0dccc043e5

status: Final

category: Question

code: HER2 (by immunohistochemistry)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

effective: 2025-03-18

performer: Practitioner Wise Owl

value: Negative (Score 0)

derivedFrom: Observation HER2 (by immunohistochemistry)


Entry 45 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Specimen/specimen-breast

Resource Specimen:

Generated Narrative: Specimen specimen-breast

identifier: http://some-lis.org/fhir/specimen-identifier-provisioner/987654321

accessionIdentifier: http://some-lis.org/fhir/specimen-identifier-provisioner/987654321X

type: Blood specimen

request: ServiceRequest Surgical pathology specimen, clerical procedure including coding of diagnoses

Collections

-Collected[x]Method
*2025-03-18 14:52:02+0000Excision (procedure)

container


Entry 46 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Patient/patient-OakleyAnnie

Resource Patient:

Generated Narrative: Patient patient-OakleyAnnie

Annie Oakley Female, DoB: 1990-06-01 ( SHID: 12446 (use: usual, ))


Other Ids:
Contact Detail
Links:

Entry 47 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Encounter/encounter-uspath-specimen-collection

Resource Encounter:

Generated Narrative: Encounter encounter-uspath-specimen-collection

identifier: http://example.com/fhir/encounters/123

status: completed

class: inpatient encounter

type: Pathology consultation, comprehensive, records and specimen with report

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

basedOn: ServiceRequest Surgical pathology specimen, clerical procedure including coding of diagnoses

participant

participant


Entry 48 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/ServiceRequest/servicerequest-cancer-path

Resource ServiceRequest:

Generated Narrative: ServiceRequest servicerequest-cancer-path

status: Active

intent: Order

category: Evaluation procedure (procedure)

code: No display for ServiceRequest.code (concept: Surgical pathology specimen, clerical procedure including coding of diagnoses)

subject: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

encounter: Encounter: identifier = http://example.com/fhir/encounters#123; status = finished; class = inpatient encounter (ActCode[3.0.0]#IMP); type = Pathology consultation, comprehensive, records and specimen with report

occurrence: 2025-03-18 17:00:14-0500

requester: PractitionerRole Ordering Provider

specimen: Specimen: identifier = http://some-lis.org/fhir/specimen-identifier-provisioner#987654321; accessionIdentifier = http://some-lis.org/fhir/specimen-identifier-provisioner#987654321X; type = Blood specimen


Entry 49 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/PractitionerRole/practitionerrole-uspath-practitioner-oncologist

Resource PractitionerRole:

Generated Narrative: PractitionerRole practitionerrole-uspath-practitioner-oncologist

practitioner: Practitioner Wise Owl

organization: Organization Redwood Women's Center, P.C.

code: Ordering Provider


Entry 50 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/PractitionerRole/practitionerrole-uspath-pathologist

Resource PractitionerRole:

Generated Narrative: PractitionerRole practitionerrole-uspath-pathologist

practitioner: Practitioner Stains Alot

organization: Organization Some Pathology Lab Name

code: Primary Interpreter


Entry 51 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/PractitionerRole/practitionerrole-uspath-surgeon

Resource PractitionerRole:

Generated Narrative: PractitionerRole practitionerrole-uspath-surgeon

practitioner: Practitioner Cuts Alot

organization: Organization Redwood Women's Center, P.C.

code: Ordering Provider


Entry 52 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Organization/organization-Redwood-Womens-Center-PC

Resource Organization:

Generated Narrative: Organization organization-Redwood-Womens-Center-PC

active: true

name: Redwood Women's Center, P.C.

Contacts

-Address
*3307 Renner Drive Fortuna CA 95540 USA

Entry 53 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Organization/organization-principal-pathology-lab

Resource Organization:

Generated Narrative: Organization organization-principal-pathology-lab

active: true

name: Some Pathology Lab Name

Contacts

-Address
*Any City CA 95540 USA

Entry 54 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Practitioner/practitioner-pathologist

Resource Practitioner:

Generated Narrative: Practitioner practitioner-pathologist

identifier: United States National Provider Identifier/1234567893

name: Stains Alot


Entry 55 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Practitioner/practitioner-oncologist

Resource Practitioner:

Generated Narrative: Practitioner practitioner-oncologist

identifier: United States National Provider Identifier/1234567893

name: Wise Owl


Entry 56 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/Practitioner/practitioner-surgeon

Resource Practitioner:

Generated Narrative: Practitioner practitioner-surgeon

identifier: United States National Provider Identifier/1234567893

name: Cuts Alot


Entry 57 - fullUrl = http://hl7.org/fhir/us/cancer-reporting/RelatedPerson/relatedperson-pathology-next-of-kin

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-pathology-next-of-kin

active: true

patient: Annie Oakley Female, DoB: 1990-06-01 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

relationship: Next-of-Kin

name: Bill Hickok

telecom: ph: 1-989-654-7896