HL7 FHIR Implementation Guide: Profiles for ICSR Transfusion and Vaccination Adverse Event Detection and Reporting
0.1.0 - STU 1 Ballot

This page is part of the Profiles for ICSR Transfusion and Vaccination Adverse Event Detection and Reporting (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

: Sample ICSR Report Patient - JSON Representation

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{
  "resourceType" : "Patient",
  "id" : "SampleICSRPatient",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/icsr-ae-reporting/StructureDefinition/ibm-fda-icsr-patient"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>MilitaryStatus</b>: <span title=\"Codes: {http://ncimeta.nci.nih.gov C114854}\">C114854</span></p><p><b>identifier</b>: id: 123456789</p><p><b>name</b>: Irma Black </p><p><b>telecom</b>: <a href=\"tel:+1-234-653-6558\">+ 1-234-653-6558</a></p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1998-08-31</p><p><b>address</b>: 50878 Coleman Ferry Montague MA US </p></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/icsr-ae-reporting/StructureDefinition/ibm-fda-icsr-ext-militarystatus",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://ncimeta.nci.nih.gov",
            "code" : "C114854"
          }
        ]
      }
    }
  ],
  "identifier" : [
    {
      "system" : "http://hl7.org/fhir/sid/us-ssn",
      "value" : "123456789"
    }
  ],
  "name" : [
    {
      "family" : "Black",
      "given" : [
        "Irma"
      ]
    }
  ],
  "telecom" : [
    {
      "system" : "phone",
      "value" : "+ 1-234-653-6558"
    }
  ],
  "gender" : "female",
  "birthDate" : "1998-08-31",
  "address" : [
    {
      "line" : [
        "50878 Coleman Ferry"
      ],
      "city" : "Montague",
      "state" : "MA",
      "country" : "US"
    }
  ]
}