Medicolegal Death Investigation (MDI) FHIR Implementation Guide
2.0.0-ballot2 - STU2 ballot United States of America flag

This page is part of the Medicolegal Death Investigation (MDI) (v2.0.0-ballot2: STU 2 Ballot 3) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

: DiagnosticReport - Toxicology Lab Result to MDI - Freeman - JSON Representation

Raw json | Download

{
  "resourceType" : "DiagnosticReport",
  "id" : "diagnosticreport-mdi-toxicology-lab-a-freeman",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/mdi/StructureDefinition/DiagnosticReport-toxicology-to-mdi"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: DiagnosticReport diagnosticreport-mdi-toxicology-lab-a-freeman</b></p><a name=\"diagnosticreport-mdi-toxicology-lab-a-freeman\"> </a><a name=\"hcdiagnosticreport-mdi-toxicology-lab-a-freeman\"> </a><a name=\"diagnosticreport-mdi-toxicology-lab-a-freeman-en-US\"> </a><h2><span title=\"Codes:{http://loinc.org 81273-5}\">fentaNYL and Norfentanyl panel - Specimen</span> (<span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0074 LAB}\">Laboratory</span>) </h2><table class=\"grid\"><tr><td>Subject</td><td>Alice J. Freeman (official) Female, DoB: 1978-03-12 ( Social Security number:\u00a0SSN#987054321\u00a0(use:\u00a0usual,\u00a0))</td></tr><tr><td>When For</td><td>2021-12-03 11:00:00+0000</td></tr><tr><td>Reported</td><td>2022-01-05 11:00:00+0000</td></tr><tr><td>Performer</td><td> <a href=\"Practitioner-us-core-practitioner-b-goldberger.html\">Practitioner Bruce Goldberger (official)</a></td></tr><tr><td>Identifier</td><td> Toxicology Laboratory Case Number/R21-01578</td></tr></table><p><b>Report Details</b></p><table class=\"grid\"><tr><td><b>Code</b></td><td><b>Value</b></td><td><b>Flags</b></td><td><b>When For</b></td></tr><tr><td><a href=\"Observation-us-core-lab-result-etoh-gas-chromatography-blood-a-freeman.html\"><span title=\"Codes:{http://loinc.org 56478-1}\">Ethanol [Mass/volume] in Blood by Gas chromatography</span></a></td><td>0.145 g/dL</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-4-anpp-blood-a-freeman.html\"><span title=\"Codes:{http://loinc.org 11072-6}\">Despropionylfentanyl [Mass/volume] in Serum or Plasma</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-acetylfentanyl-blood-a-freeman.html\"><span title=\"Codes:{http://loinc.org 86223-5}\">Acetyl norfentanyl [Mass/volume] in Serum, Plasma or Blood by Confirmatory method</span></a></td><td>2 ng/ml</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-fentanyl-blood-a-freeman.html\"><span title=\"Codes:{http://loinc.org 73938-3}\">fentaNYL [Mass/volume] in Blood by Confirmatory method</span></a></td><td>23 ng/mL</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-etoh-gas-chromatography-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 46983-3}\">Ethanol [Mass/volume] in Urine by Confirmatory method</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-4-anpp-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 11072-6}\">Despropionylfentanyl [Mass/volume] in Serum or Plasma</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-acetylfentanyl-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 74810-3}\">Acetyl fentanyl [Presence] in Urine by Confirmatory method</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-fentanyl-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 11235-9}\">fentaNYL [Presence] in Urine</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-norfentanyl-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 43199-9}\">Norfentanyl [Presence] in Urine</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-xylazine-urine-a-freeman.html\"><span title=\"Codes:{http://loinc.org 12327-3}\">Ketamine [Presence] in Urine</span></a></td><td>true</td><td>Final</td><td>2021-12-03</td></tr><tr><td><a href=\"Observation-us-core-lab-result-etoh-gas-chromatography-vit-humor-a-freeman.html\"><span title=\"Codes:{http://loinc.org 12465-1}\">Ethanol [Mass/volume] in Vitreous fluid</span></a></td><td>0.133 g/dL</td><td>Final</td><td>2021-12-03</td></tr></table><p>Samples of bile, liver, and stomach contents were contaminated and not analyzed.</p></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/mdi/StructureDefinition/Extension-tracking-number",
      "valueIdentifier" : {
        "system" : "http://florida-investigation-agncy.org/fhir/agency-case-numbers",
        "value" : "ME21-111"
      }
    }
  ],
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/mdi/CodeSystem/cs-mdi-codes",
            "code" : "tox-lab-case-number"
          }
        ]
      },
      "system" : "http://uf-path-labs.org/fhir/lab-cases",
      "value" : "R21-01578",
      "assigner" : {
        🔗 "reference" : "Organization/us-core-organization-tox-lab"
      }
    }
  ],
  "status" : "final",
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code" : "LAB"
        }
      ]
    }
  ],
  "code" : {
    "coding" : [
      {
        "system" : "http://loinc.org",
        "code" : "81273-5",
        "display" : "fentaNYL and Norfentanyl panel - Specimen"
      }
    ]
  },
  "subject" : {
    🔗 "reference" : "Patient/us-core-patient-a-freeman",
    "display" : "Alice J. Freeman"
  },
  "effectiveDateTime" : "2021-12-03T11:00:00Z",
  "issued" : "2022-01-05T11:00:00Z",
  "performer" : [
    {
      🔗 "reference" : "Practitioner/us-core-practitioner-b-goldberger"
    }
  ],
  "specimen" : [
    {
      🔗 "reference" : "Specimen/specimen-blood-toxicology-a-freeman"
    },
    {
      🔗 "reference" : "Specimen/specimen-urine-toxicology-a-freeman"
    },
    {
      🔗 "reference" : "Specimen/specimen-vitreous-humor-toxicology-a-freeman"
    },
    {
      🔗 "reference" : "Specimen/specimen-bile-toxicology-a-freeman"
    },
    {
      🔗 "reference" : "Specimen/specimen-liver-toxicology-a-freeman"
    },
    {
      🔗 "reference" : "Specimen/specimen-stomach-contents-toxicology-a-freeman"
    }
  ],
  "result" : [
    {
      🔗 "reference" : "Observation/us-core-lab-result-etoh-gas-chromatography-blood-a-freeman",
      "display" : "ETOH BLOOD: 0.145 g/dL"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-4-anpp-blood-a-freeman",
      "display" : "4-ANPP: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-acetylfentanyl-blood-a-freeman",
      "display" : "ACETYLFENTANYL: 2 ng/mL"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-fentanyl-blood-a-freeman",
      "display" : "FENTANYL: 23 ng/mL"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-etoh-gas-chromatography-urine-a-freeman",
      "display" : "ETOH URINE: 0.160 g/dL"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-4-anpp-urine-a-freeman",
      "display" : "4-ANPP: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-acetylfentanyl-urine-a-freeman",
      "display" : "ACETYLFENTANYL: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-fentanyl-urine-a-freeman",
      "display" : "FENTANYL: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-norfentanyl-urine-a-freeman",
      "display" : "NORFENTANYL: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-xylazine-urine-a-freeman",
      "display" : "XYLAZINE: POSITIVE"
    },
    {
      🔗 "reference" : "Observation/us-core-lab-result-etoh-gas-chromatography-vit-humor-a-freeman",
      "display" : "ETOH VITREOUS HUMOR: 0.133 g/dL"
    }
  ],
  "conclusion" : "Samples of bile, liver, and stomach contents were contaminated and not analyzed."
}