Birth And Fetal Death (BFDR) - STU2-ballot
2.0.0-ballot - ballot United States of America flag

This page is part of the Vital Records Birth and Fetal Death Reporting (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Live Birth Report Example - Baby G Quinn

This example provides a narrative description of the live birth report for Baby Girl Quinn, following the birth report form. This information is transmitted in both a Provider bundle to the VRO, and in a Jurisdiction bundle to NCHS. The main difference between the two bundles is the inclusion of edit flags.

Field(s) Example Instance  
Child Baby Girl Quinn, Time of Birth: 2019-02-12 07:00  
Mother Jada Ann Quinn  
Mother Married Married  
SSN REquested Yes  
Paternity Acknowledged Yes  
Father James Brandon Quinn  
Attendant Avery Jones see Birth Encounter  
Mother’s Education Post-Graduate  
Mother’s Usual Work-Occupation Carpenter  
Mother’s Usual Work-Industry Construction  
Mother’s Race and Ethnicity White/AmericanIndian, Non-Hispanic  
Father’s Education Post Graduate  
Father’s Usual Work-Occupation Lawyer  
Father’s Usual Work-Industry Legal Services  
Father’s Race and Ethnicity White / Non-Hispanic  
Place of Birth Birth at South Hospital , Discharge to East Hospital  
Certifier Janet Seito  
First Prenatal Care 2018-07-20  
Number of Prenatal Care Visits 8  
Mother’s Height 67 in  
Mother’s Prepregnancy Weight 145 lb  
Mother’s Weight at Delivery 175 lb  
Mother WIC Food Yes  
Cigarette Smoking Prepregnancy = 20, First Trimester = 3, Second Trimester = 1, Third Trimester = 0  
Number of Previous Live Births Living = 1, Dead = 0  
Other Pregnancy Outcomes Other Outcomes = 0  
Last Live Outcome 2014-11-20  
Last Other Outcomes 2015-05  
Last Normal Menses 2018-06-05  
Risk Factors During Pregnancy Gestational Hypertension, Infertility Treatment, Artificial Insemination, Previous Caesarean = 1']  
Obstetric Procedures External Cephalic Version - Unsuccessful  
Infections During Pregnancy Chlamidiya  
Characteristics of Labor and Delivery Induction, Antibiotics, ChorioAmnioontis, Epidural  
Maternal Morbidity Ruptured Uterus  
Newborn Birthweight 2500g  
Fetal Presentation Breech  
Final Route/Method of Delivery Caesarean with trial labor attempted  
Obstetric Estimate of Gestation 36 wk  
Apgar Score 1min = 5, 5min = 7  
Maternal Morbidity Ruptured Uterus  
Plurality / Birth Order Plurality = 1 , Order = 1  
Abnormal Conditions of the Newborn Antibiotics Received  
Congenital Anomolies of the Newborn Cyanotic Congenital Heart Disease 1, Chrom21  
Infant Living Yes  
Infant Breastfed Yes  
Infant Transferred Yes  
Payer PRIVATE HEALTH INSURANCE