Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/DeathCertificate-Example2

Resource Composition:

Generated Narrative: Composition DeathCertificate-Example2

Filing Format: Electronic

Replacement Status of a Death Record (deprecated): original record

State Specific Field: State Specific Content

status: Final

type: Death certificate

date: 2020-11-15 16:39:54-0500

author: Practitioner Jim Black (official)

title: Death Certificate

Attesters

-	Mode	Time	Party
*	Legal	2020-11-14 16:39:40-0500	Practitioner Jim Black (official)

Events

-	Code	Detail
*	Death certificate (record artifact)	Procedure Death certification

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/Decedent-Example1

Resource Patient:

Generated Narrative: Patient Decedent-Example1

Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

---

Marital Status:	Never Married
Contact Detail	5590 Lockwood Drive Danville VA US
Unknown:	Joe Smith
NVSS SexAtDeath	Unknown
Spouse Is Alive	Yes
Patient Birth Place	Roanoke VA US

Entry 3 - fullUrl = http://www.example.org/fhir/RelatedPerson/DecedentFather-Example1

Resource RelatedPerson:

Generated Narrative: RelatedPerson DecedentFather-Example1

active: true

patient: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

relationship: father

name: Decedent Dad(Official)

Entry 4 - fullUrl = http://www.example.org/fhir/RelatedPerson/DecedentMother-Example1

Resource RelatedPerson:

Generated Narrative: RelatedPerson DecedentMother-Example1

active: true

patient: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

relationship: mother

name: Decedent Mom(Name changed for Marriage)

Entry 5 - fullUrl = http://www.example.org/fhir/RelatedPerson/DecedentSpouse-Example1

Resource RelatedPerson:

Generated Narrative: RelatedPerson DecedentSpouse-Example1

active: true

patient: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

relationship: spouse

name: Decedent Spouse(Name changed for Marriage)

Entry 6 - fullUrl = http://www.example.org/fhir/Observation/DecedentAge-Example1

Resource Observation:

Generated Narrative: Observation DecedentAge-Example1

status: Final

code: Age at death

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: 42 years (Details: UCUM codea = 'a')

Entry 7 - fullUrl = http://www.example.org/fhir/Observation/InputRaceAndEthnicity-Example1

Resource Observation:

Generated Narrative: Observation InputRaceAndEthnicity-Example1

status: Final

code: Input Race and Ethnicity

subject: NCHS generated

component

code: White

value: true

component

code: Black Or African American

value: false

component

code: American Indian Or Alaska Native

value: true

component

code: Asian Indian

value: false

component

code: Chinese

value: false

component

code: Filipino

value: false

component

code: Japanese

value: false

component

code: Korean

value: false

component

code: Vietnamese

value: false

component

code: Other Asian

value: true

component

code: Native Hawaiian

value: false

component

code: Guamanian Or Chamorro

value: false

component

code: Samoan

value: false

component

code: Other Pacific Islander

value: false

component

code: Other Race

value: false

component

code: First Other Asian Literal

value: Malaysian

component

code: First American Indian Or Alaska Native Literal

value: Arikara

component

code: Hispanic Mexican

value: Yes

component

code: Hispanic Cuban

value: Yes

component

code: Hispanic Puerto Rican

value: Yes

component

code: Hispanic Other

value: No

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/BirthRecordIdentifier-Example1

Resource Observation:

Generated Narrative: Observation BirthRecordIdentifier-Example1

status: Final

code: Birth Record Identifier of Child

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: 717171

component

code: Birthplace

value: YC

component

code: Birth year

value: 1961

Entry 9 - fullUrl = http://www.example.org/fhir/Observation/DecedentEducationLevel-Example1

Resource Observation:

Generated Narrative: Observation DecedentEducationLevel-Example1

status: Final

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

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Some secondary or high school education

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/DecedentMilitaryService-Example1

Resource Observation:

Generated Narrative: Observation DecedentMilitaryService-Example1

status: Final

code: Military service Narrative

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Yes

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/DecedentUsualWork-Example1

Resource Observation:

Generated Narrative: Observation DecedentUsualWork-Example1

status: Final

code: History of Usual occupation

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: secretary

Components

-	Code	Value[x]
*	History of Usual industry	State agency

Entry 12 - fullUrl = http://www.example.org/fhir/Observation/EmergingIssues-Example1

Resource Observation:

Generated Narrative: Observation EmergingIssues-Example1

status: Final

code: Emerging Issues

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

component

code: EmergingIssue1_1

value: H

component

code: EmergingIssue1_2

value: I

component

code: EmergingIssue8_1

value: Hi 8_1

component

code: EmergingIssue20

value: Hi 20_1

Entry 13 - fullUrl = http://www.example.org/fhir/Observation/DecedentPregnancyStatus-Example1

Resource Observation:

Generated Narrative: Observation DecedentPregnancyStatus-Example1

status: Final

code: Timing of recent pregnancy in relation to death

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Pregnant at time of death

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/TobaccoUseContributedToDeath-Example1

Resource Observation:

Generated Narrative: Observation TobaccoUseContributedToDeath-Example1

status: Final

code: Did tobacco use contribute to death

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Yes

Entry 15 - fullUrl = http://www.example.org/fhir/Observation/DeathDate-Example2

Resource Observation:

Generated Narrative: Observation DeathDate-Example2

status: Final

code: Date and time of death [TimeStamp]

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

effective: 2020-11-12 16:39:40-0500

performer: Practitioner Jane Purple (official)

value: Partial Date Time Vital Records:

component

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

value: 2020-11-13 16:39:40-0500

component

code: Location of death

value: Death in hospital

Entry 16 - fullUrl = http://www.example.org/fhir/Practitioner/Pronouncer-Example1

Resource Practitioner:

Generated Narrative: Practitioner Pronouncer-Example1

identifier: NPI/9941339101

name: Jane Purple (Official)

address: 44 South Street Rockville MD 20854 US

Entry 17 - fullUrl = http://www.example.org/fhir/Observation/SurgeryDate-Example1

Resource Observation:

Generated Narrative: Observation SurgeryDate-Example1

status: Final

code: Date and time of surgery

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

effective: 2019-11-12

Entry 18 - fullUrl = http://www.example.org/fhir/Observation/ExaminerContacted-Example1

Resource Observation:

Generated Narrative: Observation ExaminerContacted-Example1

status: Final

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

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Yes

Entry 19 - fullUrl = http://www.example.org/fhir/Observation/MannerOfDeath-Example1

Resource Observation:

Generated Narrative: Observation MannerOfDeath-Example1

status: Final

code: Manner of death

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performer: Practitioner Jim Black (official)

value: Natural death

Entry 20 - fullUrl = http://www.example.org/fhir/Location/DeathLocation-Example1

Resource Location:

Generated Narrative: Location DeathLocation-Example1

name: Pecan Grove Nursing Home

description: nursing home

type: Death Location

address: Albany NY US

Positions

-	Longitude	Latitude
*	-77.050636	38.889248

Entry 21 - fullUrl = http://www.example.org/fhir/Location/InjuryLocation-Example1

Resource Location:

Generated Narrative: Location InjuryLocation-Example1

name: Home

description: 5590 Lockwood Drive 20621 US

type: Injury Location

address: 5590 Lockwood Drive 20621 US

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/InjuryIncident-Example2

Resource Observation:

Generated Narrative: Observation InjuryIncident-Example2

status: Final

code: Injury incident description Narrative

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

effective: 2019-11-02 13:00:00-0500

value: drug toxicity

component

code: Did death result from injury at work

value: No

component

code: Place of injury Facility

value: Home

component

code: Transportation role of decedent

value: Pedestrian

Entry 23 - fullUrl = http://www.example.org/fhir/Practitioner/Certifier-Example1

Resource Practitioner:

Generated Narrative: Practitioner Certifier-Example1

Practitioner Role: Certifier

identifier: NPI/9941339100

name: Jim Black (Official)

address: 44 South Street Bird in Hand PA 17505 US

Entry 24 - fullUrl = http://www.example.org/fhir/Procedure/DeathCertification-Example1

Resource Procedure:

Generated Narrative: Procedure DeathCertification-Example1

identifier: 180

status: Completed

code: Death certification

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performed: 2020-11-14 16:39:40-0500

Performers

-	Function	Actor
*	Nurse Practitioner	Practitioner Jim Black (official)

Entry 25 - fullUrl = http://www.example.org/fhir/Observation/CauseOfDeathPart1-Example1

Resource Observation:

Generated Narrative: Observation CauseOfDeathPart1-Example1

status: Final

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

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performer: Practitioner Jim Black (official)

value: Cardiopulmonary arrest

component

code: line number

value: 1

component

code: Disease onset to death interval

value: 4 hours

Entry 26 - fullUrl = http://www.example.org/fhir/Observation/CauseOfDeathPart1-Example2

Resource Observation:

Generated Narrative: Observation CauseOfDeathPart1-Example2

status: Final

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

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performer: Practitioner Jim Black (official)

value: Eclampsia

component

code: line number

value: 2

component

code: Disease onset to death interval

value: 3 months

Entry 27 - fullUrl = http://www.example.org/fhir/Observation/CauseOfDeathPart2-Example1

Resource Observation:

Generated Narrative: Observation CauseOfDeathPart2-Example1

status: Final

code: Other significant causes or conditions of death

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performer: Practitioner Jim Black (official)

value: hypertensive heart disease

Entry 28 - fullUrl = http://www.example.org/fhir/Location/DispositionLocation-Example1

Resource Location:

Generated Narrative: Location DispositionLocation-Example1

name: Rosewood Cemetary

type: Disposition Location

address: 303 Rosewood Ave Danville VA 24541 US

physicalType: Site

Entry 29 - fullUrl = http://www.example.org/fhir/Organization/FuneralHome-Example1

Resource Organization:

Generated Narrative: Organization FuneralHome-Example1

active: true

type: Funeral Home

name: Lancaster Funeral Home and Crematory

address: 211 High Street Lancaster PA 17573 US

Entry 30 - fullUrl = http://www.example.org/fhir/Observation/DecedentDispositionMethod-Example1

Resource Observation:

Generated Narrative: Observation DecedentDispositionMethod-Example1

status: Final

code: Body disposition method

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

performer: Practitioner Ronald Q Smith (official)

value: Burial

Entry 31 - fullUrl = http://www.example.org/fhir/Observation/AutopsyPerformedIndicator-Example1

Resource Observation:

Generated Narrative: Observation AutopsyPerformedIndicator-Example1

status: Final

code: Autopsy was performed

subject: Madelyn Patel (official) Female, DoB: 1978-03-12 ( Social Beneficiary Identifier: SSN#987654321)

value: Yes

Components

-	Code	Value[x]
*	Autopsy results available	Yes

Entry 32 - fullUrl = http://www.example.org/fhir/Practitioner/Mortician-Example1

Resource Practitioner:

Generated Narrative: Practitioner Mortician-Example1

Practitioner Role: Mortician

identifier: NPI/212222AB

name: Ronald Q Smith (Official)

Entry 33 - fullUrl = http://www.example.org/fhir/Observation/ActivityAtTimeOfDeath-Example1

Resource Observation:

Generated Narrative: Observation ActivityAtTimeOfDeath-Example1

status: Final

code: Activity at time of death [CDC]

subject: NCHS generated

value: While engaged in leisure activities.

Entry 34 - fullUrl = http://www.example.org/fhir/Observation/CodedRaceAndEthnicity-Example1

Resource Observation:

Generated Narrative: Observation CodedRaceAndEthnicity-Example1

status: Final

code: Coded Race and Ethnicity

subject: NCHS generated

component

code: First Edited Race Code

value: White

component

code: Second Edited Race Code

value: Israeli

component

code: First Edited American Indian Race Code

value: Arikara

component

code: Race Recode 40

value: AIAN and Asian

component

code: Hispanic Code

value: Chilean

Entry 35 - fullUrl = http://www.example.org/fhir/Observation/ManualUnderlyingCauseOfDeath-Example1

Resource Observation:

Generated Narrative: Observation ManualUnderlyingCauseOfDeath-Example1

status: Final

code: Cause of death.underlying [Manual]

subject: NCHS generated

value: Acute respiratory failure

Entry 36 - fullUrl = http://www.example.org/fhir/Observation/AutomatedUnderlyingCauseOfDeath-Example1

Resource Observation:

Generated Narrative: Observation AutomatedUnderlyingCauseOfDeath-Example1

status: Final

code: Cause of death.underlying [Automated]

subject: NCHS generated

value: Acute respiratory failure

Entry 37 - fullUrl = http://www.example.org/fhir/Observation/RecordAxisCauseOfDeath-Example1

Resource Observation:

Generated Narrative: Observation RecordAxisCauseOfDeath-Example1

status: Final

code: Cause of death record axis code [Automated]

subject: NCHS generated

value: Acute respiratory failure

Components

-	Code	Value[x]
*	position	1

Entry 38 - fullUrl = http://www.example.org/fhir/Observation/EntityAxisCauseOfDeath-Example1

Resource Observation:

Generated Narrative: Observation EntityAxisCauseOfDeath-Example1

status: Final

code: Cause of death entity axis code [Automated]

subject: NCHS generated

value: Acute respiratory failure

component

code: line number

value: 1

component

code: position

value: 1

Entry 39 - fullUrl = http://www.example.org/fhir/Observation/PlaceOfInjury-Example1

Resource Observation:

Generated Narrative: Observation PlaceOfInjury-Example1

status: Final

code: Injury location

subject: NCHS generated

value: Home

Entry 40 - fullUrl = http://www.example.org/fhir/Parameters/CodingStatusValues-Example1

Resource Parameters:

Generated Narrative: Parameters CodingStatusValues-Example1

Parameters

shipmentNumber	A2B2
receiptDate	2021-12-12
coderStatus	5
intentionalReject	Reject1
acmeSystemReject	Not Rejected
transaxConversion	Conversion using non-ambivalent table entries