Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/composition-mdi-dcr-ex1

Resource Composition:

Generated Narrative: Composition composition-mdi-dcr-ex1

Extension - Tracking Number: Death Certificate File Number/123456

Extension - Death Certificate Status

• DCcertification: Certified
• DCregistration: Not Registered

status: Final

type: Death administrative information Document

date: 2023-05-02

author: Organization GA Dept Public Health

title: Death Certificate Review request for death data quality

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/vrdr-decedent-dcr-ex1

Resource Patient:

Generated Narrative: Patient vrdr-decedent-dcr-ex1

Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

---

Marital Status:	Never Married
Alt. Name:	Joey (Name changed for Marriage)
Contact Detail	23 N Lockfield Street H Unknown CT US
father:	Dad Father (Official) 345 Main Street Abington CT 06230 US ph: 6765432345
US Core Ethnicity Extension:	ombCategory: CDC Race and Ethnicity 2186-5: Not Hispanic or Latino text: No, not Spanish/Hispanic/Latino
Patient Birth Place	Alberia AF
US Core Birth Sex Extension	UNK
US Core Race Extension:	detailed: CDC Race and Ethnicity 2131-1: Other Race text: Other (Specify)|Unknown

Entry 3 - fullUrl = http://www.example.org/fhir/Organization/us-core-organization-ga-dph

Resource Organization:

Generated Narrative: Organization us-core-organization-ga-dph

active: true

type: Government

name: GA Dept Public Health

Contacts

-	Telecom	Address
*	ph: (404) 123-4567	1234 Main Street Anytown GA 30349 US

Entry 4 - fullUrl = http://www.example.org/fhir/RelatedPerson/vrdr-decedent-father-dcr-ex1

Resource RelatedPerson:

Generated Narrative: RelatedPerson vrdr-decedent-father-dcr-ex1

active: true

patient: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

relationship: father

name: Dad Father

Entry 5 - fullUrl = http://www.example.org/fhir/RelatedPerson/vrdr-decedent-mother-dcr-ex1

Resource RelatedPerson:

Generated Narrative: RelatedPerson vrdr-decedent-mother-dcr-ex1

active: true

patient: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

relationship: mother

name: Mom Mother

Entry 6 - fullUrl = http://www.example.org/fhir/Observation/vrdr-decedent-age-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-decedent-age-dcr-ex1

status: Final

code: Age at death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: 39 a (Details: UCUM codea = 'a')

Entry 7 - fullUrl = http://www.example.org/fhir/Observation/vrdr-decedent-education-level-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-decedent-education-level-dcr-ex1

status: Final

code: Highest level of education [US Standard Certificate of Death]

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Unknown

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/vrdr-decedent-military-service-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-decedent-military-service-dcr-ex1

status: Final

code: Military service Narrative

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: No

Entry 9 - fullUrl = http://www.example.org/fhir/Observation/vrdr-examiner-contacted-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-examiner-contacted-dcr-ex1

status: Final

code: Medical examiner or coroner was contacted [US Standard Certificate of Death]

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Yes

Components

-	Code	Value[x]
*	Coroner - medical examiner case number	23-00083

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/vrdr-decedent-pregnancy-status-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-decedent-pregnancy-status-dcr-ex1

status: Final

code: Timing of recent pregnancy in relation to death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Not pregnant within past year

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/vrdr-tobacco-use-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-tobacco-use-dcr-ex1

status: Final

code: Did tobacco use contribute to death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Unknown

Entry 12 - fullUrl = http://www.example.org/fhir/Location/vrdr-death-location-dcr-ex1

Resource Location:

Generated Narrative: Location vrdr-death-location-dcr-ex1

identifier: http://Tahoe.Web/Insurity.Tahoe.Organization.Entity.BusinessUnitCode/LOADED_FACILITY_20022

name: Lawrence & Memorial Hospital

type: Death Location

address: 123 Any Street Wayne MI 48184 US

Entry 13 - fullUrl = http://www.example.org/fhir/Location/vrdr-injury-location-dcr-ex1

Resource Location:

Generated Narrative: Location vrdr-injury-location-dcr-ex1

name: Home

type: Injury Location

address: 1 Two Street Kennesaw GA 30144 US

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/vrdr-injury-incident-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-injury-incident-dcr-ex1

status: Final

code: Injury incident description

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

effective: 2000-01-01

value: shot by other

Components

-	Code	Value[x]
*	Did death result from injury at work	No

Entry 15 - fullUrl = http://www.example.org/fhir/Observation/vrdr-autopsy-performed-indicator-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-autopsy-performed-indicator-dcr-ex1

status: Final

code: Autopsy was performed

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Yes

Components

-	Code	Value[x]
*	Autopsy results available	Yes

Entry 16 - fullUrl = http://www.example.org/fhir/Observation/vrdr-death-date-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-death-date-dcr-ex1

status: Final

code: Date+time of death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

effective: 2023-04-24 01:00:00-0400

performer: Practitioner Lm Doctor (official)

value: 2023-04-24 01:00:00-0400

component

code: Date and time pronounced dead [US Standard Certificate of Death]

value: 2023-04-24 14:00:00-0400

component

code: Location of death

value: Death in hospital

Entry 17 - fullUrl = http://www.example.org/fhir/Practitioner/vr-practitioner-ex1

Resource Practitioner:

Generated Narrative: Practitioner vr-practitioner-ex1

identifier: NPI/456789

name: Medical B Examiner (Official)

address: Kennesaw GA 30144 US

Entry 18 - fullUrl = http://www.example.org/fhir/Practitioner/us-core-practitioner-dcr-ex1

Resource Practitioner:

Generated Narrative: Practitioner us-core-practitioner-dcr-ex1

identifier: NPI/1234567

name: Lm Doctor (Official)

Qualifications

-	Code
*	Medical doctor

Entry 19 - fullUrl = http://www.example.org/fhir/Procedure/vrdr-death-certification-dcr-ex1

Resource Procedure:

Generated Narrative: Procedure vrdr-death-certification-dcr-ex1

status: Completed

code: Death certification

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

Performers

-	Function	Actor
*	Death certification by medical examiner or coroner (procedure)	Practitioner Medical A Examiner (official)

Entry 20 - fullUrl = http://www.example.org/fhir/Observation/vrdr-manner-of-death-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-manner-of-death-dcr-ex1

status: Final

code: Manner of death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

performer: Practitioner Lm Doctor (official)

value: Homicide

Entry 21 - fullUrl = http://www.example.org/fhir/Observation/vrdr-cause-of-death-part1-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-cause-of-death-part1-dcr-ex1

status: Final

code: Cause of death [US Standard Certificate of Death]

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

value: Gunshot Wound of Head

component

code: line number

value: 1

component

code: Disease onset to death interval

value: 1 hour

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/vrdr-cause-of-death-part2-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-cause-of-death-part2-dcr-ex1

status: Final

code: Other significant causes or conditions of death

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

performer: Practitioner Medical A Examiner (official)

value: Arteriosclerosis

Entry 23 - fullUrl = http://www.example.org/fhir/Location/vrdr-disposition-location-dcr-ex1

Resource Location:

Generated Narrative: Location vrdr-disposition-location-dcr-ex1

name: Affordable Cremations, LLC

type: Disposition Location

address: BARRETT PARKWAY GA US

Entry 24 - fullUrl = http://www.example.org/fhir/Organization/vrdr-funeral-home-dcr-ex1

Resource Organization:

Generated Narrative: Organization vrdr-funeral-home-dcr-ex1

identifier: 139

active: true

type: Funeral Home

name: Byles-Macdougall Funeral Service (New London)

Contacts

-	Address
*	88 Huntington St Kennesaw GA 30144 US

Entry 25 - fullUrl = http://www.example.org/fhir/Observation/vrdr-decedent-disposition-method-dcr-ex1

Resource Observation:

Generated Narrative: Observation vrdr-decedent-disposition-method-dcr-ex1

status: Final

code: Body disposition method

subject: Testing R Joey (official) Unknown, DoB: 2023-01-01 ( Social Beneficiary Identifier: SSN#234567865)

effective: 2023-04-29

performer: Practitioner Donald W Byles (official)

value: Cremation

Entry 26 - fullUrl = http://www.example.org/fhir/Practitioner/vrdr-mortician-dcr-ex1

Resource Practitioner:

Generated Narrative: Practitioner vrdr-mortician-dcr-ex1

Practitioner Role: Mortician

identifier: NPI/199612AB

name: Donald W Byles (Official)

Entry 27 - fullUrl = http://www.example.org/fhir/Practitioner/vrdr-certifier-dcr-ex1

Resource Practitioner:

Generated Narrative: Practitioner vrdr-certifier-dcr-ex1

Practitioner Role: Certifier

identifier: NPI/987654

name: Medical A Examiner (Official)

address: Kennesaw GA 30144 US