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
<Patient xmlns="http://hl7.org/fhir">
<id value="SampleICSRPatient"/>
<meta>
<profile
value="http://hl7.org/fhir/us/icsr-ae-reporting/StructureDefinition/ibm-fda-icsr-patient"/>
</meta>
<text>
<status value="extensions"/>
<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>
</text>
<extension
url="http://hl7.org/fhir/us/icsr-ae-reporting/StructureDefinition/ibm-fda-icsr-ext-militarystatus">
<valueCodeableConcept>
<coding>
<system value="http://ncimeta.nci.nih.gov"/>
<code value="C114854"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system value="http://hl7.org/fhir/sid/us-ssn"/>
<value value="123456789"/>
</identifier>
<name>
<family value="Black"/>
<given value="Irma"/>
</name>
<telecom>
<system value="phone"/>
<value value="+ 1-234-653-6558"/>
</telecom>
<gender value="female"/>
<birthDate value="1998-08-31"/>
<address>
<line value="50878 Coleman Ferry"/>
<city value="Montague"/>
<state value="MA"/>
<country value="US"/>
</address>
</Patient>