This page is part of the Vital Records Death Reporting FHIR Implementation Guide (v3.0.0-ballot: STU 3 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.2.0. For a full list of available versions, see the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="MortalityRosterBundle-Example1"/>
<meta>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/AliasStatus">
<valueBoolean value="false"/>
</extension>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/ReplaceStatus">
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-replace-status-cs"/>
<code value="original"/>
<display value="original record"/>
</coding>
</valueCodeableConcept>
</extension>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-mortality-roster-bundle"/>
</meta>
<identifier>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/CertificateNumber">
<valueString value="000182"/>
</extension>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/AuxiliaryStateIdentifier1">
<valueString value="000000000001"/>
</extension>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/AuxiliaryStateIdentifier2">
<valueString value="100000000001"/>
</extension>
<value value="2020NY000182"/>
</identifier>
<type value="collection"/>
<timestamp value="2020-10-20T14:48:35.401641-04:00"/>
<entry>
<fullUrl value="http://www.example.org/fhir/Patient/Decedent-Example3"/>
<resource>
<Patient>
<id value="Decedent-Example3"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-decedent"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_Decedent-Example3"> </a><p><b>Generated Narrative: Patient</b><a name="Decedent-Example3"> </a><a name="hcDecedent-Example3"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Patient "Decedent-Example3" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vrdr-decedent.html">Decedent</a></p></div><p><b>NVSS SexAtDeath</b>: Unknown <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a>#unknown)</span></p><p><b>Birth Place</b>: NY US </p><p><b>identifier</b>: Social Beneficiary Identifier/987654321</p><p><b>name</b>: Madelyn Patel (Official), Joyce McCain(Name changed for Marriage)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: ??</p><p><b>address</b>: NY </p></div>
</text>
<extension
url="http://hl7.org/fhir/us/vrdr/StructureDefinition/NVSS-SexAtDeath">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="unknown"/>
<display value="Unknown"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthPlace">
<valueAddress>
<state value="NY"/>
<country value="US"/>
</valueAddress>
</extension>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="SB"/>
<display value="Social Beneficiary Identifier"/>
</coding>
</type>
<system value="http://hl7.org/fhir/sid/us-ssn"/>
<value value="987654321"/>
</identifier>
<name>
<use value="official"/>
<family value="Patel"/>
<given value="Madelyn"/>
</name>
<name>
<use value="maiden"/>
<text value="Joyce McCain"/>
<family value="McCain"/>
<given value="Joyce"/>
</name>
<gender value="female"/>
<birthDate>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/ExtensionPartialDateTimeVitalRecords">
<extension url="day">
<valueUnsignedInt value="10"/>
</extension>
<extension url="month">
<valueUnsignedInt value="11"/>
</extension>
<extension url="year">
<valueUnsignedInt value="2004"/>
</extension>
</extension>
</birthDate>
<address>
<state value="NY"/>
</address>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/RelatedPerson/DecedentFather-Example1"/>
<resource>
<RelatedPerson>
<id value="DecedentFather-Example1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-decedent-father"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_DecedentFather-Example1"> </a><p><b>Generated Narrative: RelatedPerson</b><a name="DecedentFather-Example1"> </a><a name="hcDecedentFather-Example1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource RelatedPerson "DecedentFather-Example1" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vrdr-decedent-father.html">Decedent Father</a></p></div><p><b>active</b>: true</p><p><b>patient</b>: <a href="Patient-Decedent-Example1.html">Patient/Decedent-Example1</a> " PATEL"</p><p><b>relationship</b>: father <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-RoleCode.html">RoleCode</a>#FTH)</span></p><p><b>name</b>: Decedent Dad(Official)</p></div>
</text>
<active value="true"/>
<patient>🔗
<reference value="Patient/Decedent-Example1"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="FTH"/>
</coding>
</relationship>
<name>
<use value="official"/>
<text value="Decedent Dad"/>
<family value="Smith"/>
<given value="John"/>
<suffix value="Sr"/>
</name>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/RelatedPerson/DecedentMother-Example1"/>
<resource>
<RelatedPerson>
<id value="DecedentMother-Example1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-decedent-mother"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_DecedentMother-Example1"> </a><p><b>Generated Narrative: RelatedPerson</b><a name="DecedentMother-Example1"> </a><a name="hcDecedentMother-Example1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource RelatedPerson "DecedentMother-Example1" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vrdr-decedent-mother.html">Decedent Mother</a></p></div><p><b>active</b>: true</p><p><b>patient</b>: <a href="Patient-Decedent-Example1.html">Patient/Decedent-Example1</a> " PATEL"</p><p><b>relationship</b>: mother <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-RoleCode.html">RoleCode</a>#MTH)</span></p><p><b>name</b>: Decedent Mom(Name changed for Marriage)</p></div>
</text>
<active value="true"/>
<patient>🔗
<reference value="Patient/Decedent-Example1"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="MTH"/>
</coding>
</relationship>
<name>
<use value="maiden"/>
<text value="Decedent Mom"/>
<family value="Suzette"/>
<given value="Jane"/>
</name>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/DeathDate-Example3"/>
<resource>
<Observation>
<id value="DeathDate-Example3"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-date"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_DeathDate-Example3"> </a><p><b>Generated Narrative: Observation</b><a name="DeathDate-Example3"> </a><a name="hcDeathDate-Example3"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Observation "DeathDate-Example3" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vrdr-death-date.html">Observation - Death Date</a></p></div><p><b>status</b>: final</p><p><b>code</b>: Date+time of death <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://loinc.org/">LOINC</a>#81956-5)</span></p><p><b>subject</b>: See on this page: Patient/Decedent-Example3</p><p><b>effective</b>: 2020-11-12 16:39:40-0500</p><p><b>value</b>: ??</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="81956-5"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/Decedent-Example3"/>
</subject>
<effectiveDateTime value="2020-11-12T16:39:40-05:00"/>
<valueDateTime>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/ExtensionPartialDateTimeVitalRecords">
<extension url="day">
<valueUnsignedInt>
<extension
url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
<valueCode value="unknown"/>
</extension>
</valueUnsignedInt>
</extension>
<extension url="month">
<valueUnsignedInt value="11"/>
</extension>
<extension url="year">
<valueUnsignedInt value="2020"/>
</extension>
<extension url="time">
<valueTime>
<extension
url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
<valueCode value="unknown"/>
</extension>
</valueTime>
</extension>
</extension>
</valueDateTime>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Location/DeathLocation-Example3"/>
<resource>
<Location>
<id value="DeathLocation-Example3"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-location"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_DeathLocation-Example3"> </a><p><b>Generated Narrative: Location</b><a name="DeathLocation-Example3"> </a><a name="hcDeathLocation-Example3"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Location "DeathLocation-Example3" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vrdr-death-location.html">Death Location</a></p></div><p><b>name</b>: Pecan Grove Nursing Home</p><p><b>type</b>: Death Location <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-vrdr-location-type-cs.html">Location Type</a>#death)</span></p><p><b>address</b>: NY US </p></div>
</text>
<name value="Pecan Grove Nursing Home"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-location-type-cs"/>
<code value="death"/>
</coding>
</type>
<address>
<state value="NY"/>
<country value="US"/>
</address>
</Location>
</resource>
</entry>
</Bundle>