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 - XML Representation

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<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>