Bundle - Provider Fetal Death Report - Fetus Not Named - Birth And Fetal Death (BFDR) FHIR Implementation Guide v2.0.0

This page is part of the Vital Records Birth and Fetal Death Reporting (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: Bundle - Provider Fetal Death Report - Fetus Not Named

Document Details

Generated Narrative: Bundle Provider fetal death report Document

Document Subject

Unable to resolve subject ''

Document Content

Generated Narrative: Composition composition-provider-fetal-death-not-named

status: Final

type: U.S. standard report of fetal death - 2003 revision

encounter: Encounter: extension = mother; identifier = http://hospital.smarthealthit.org#8937015; status = finished; class = inpatient encounter (ActCode#IMP); type = Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.; period = 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700

date: 2019-01-09

author: Practitioner Leung Jessica

title: Provider fetal death report Document

Prenatal records

Clinical information

Fetal delivery information Document [US Standard Report of Fetal Death]

Mother's administrative information

Father's administrative information

Patient's QuestionnaireResponse Section

Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/composition-provider-fetal-death-not-named

Resource Composition:

Generated Narrative: Composition composition-provider-fetal-death-not-named

status: Final
type: U.S. standard report of fetal death - 2003 revision
encounter: Encounter: extension = mother; identifier = http://hospital.smarthealthit.org#8937015; status = finished; class = inpatient encounter (ActCode#IMP); type = Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.; period = 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700
date: 2019-01-09
author: Practitioner Leung Jessica
title: Provider fetal death report Document

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/patient-decedent-fetus-not-named

Resource Patient:

Generated Narrative: Patient patient-decedent-fetus-not-named

null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))
Deceased: true Multiple Birth: 3
Reported Parent Age At Delivery Vital Records:
reportedAge: 34 a (Details: UCUM codea = 'a')
motherOrFather: mother
Reported Parent Age At Delivery Vital Records:
reportedAge: 35 a (Details: UCUM codea = 'a')
motherOrFather: father
Patient Birth Place Ann Arbor MI 48103
US Core Birth Sex Extension F

Entry 3 - fullUrl = http://www.example.org/fhir/Encounter/encounter-maternity-carmen-teresa-lee

Resource Encounter:

Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee

Extension Parental Role: mother
identifier: http://hospital.smarthealthit.org/8937015
status: Finished
class: ActCode IMP: inpatient encounter
type: Under Observation or Inpatient Care Services (Including Admission and Discharge Services)
subject: Patient - Mother (Carmen Teresa Lee)
Participants
- Type Individual
* Birth attendant [Extended Identifier] Practitioner - Vital Records (Janet Seito, DO)
period: 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700
Locations
- Location PhysicalType
* Location - US Core Location (South Hospital) Hospital
serviceProvider: Organization - US Core Organization (South Hospital Organization)

Entry 4 - fullUrl = http://www.example.org/fhir/Patient/patient-mother-carmen-teresa-lee

Resource Patient:

Generated Narrative: Patient patient-mother-carmen-teresa-lee

Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
Alt. Name: Carmen Teresa Santos (Name changed for Marriage)
Contact Detail 3670 Miller Road Ann Arbor MI 48103 US (home)
Links:
Also see: RelatedPerson Carmen Teresa Lee (official)
US Core Ethnicity Extension:
ombCategory: CDC Race and Ethnicity 2135-2: Hispanic or Latino
text: Hispanic or Latino
Patient Birth Place PR
US Core Birth Sex Extension F
US Core Race Extension:
ombCategory: CDC Race and Ethnicity 2054-5: Black or African American
text: Black or African America

Entry 5 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee

status: Final
code: Date first prenatal visit
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2018-05-18

Entry 6 - fullUrl = http://www.example.org/fhir/Observation/observation-last-menstrual-period-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee

status: Final
code: Last menstrual period start date
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2018-05-02
performer: Practitioner Janet Seito
value: 2018-04-18

Entry 7 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-living-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee

status: Final
code: [#] Births.still living
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 1

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-dead-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee

status: Final
code: Previous live births now dead #
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 0

Entry 9 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-live-birth-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee

status: Final
code: Date of last live birth
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2016-01-28

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-height-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-height-carmen-teresa-lee

status: Final
category: Vital Signs
code: Body height
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-01-10
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 65 in (Details: UCUM code[in_i] = '[in_i]')

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee

status: Final
category: Vital Signs
code: Body weight --pre current pregnancy
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

Entry 12 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-received-wic-food-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee

status: Final
code: Mother WIC food recipient
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: No

Entry 13 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee

status: Final
code: In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 0

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee

status: Final
code: Cigarettes smoked per day by Mother--1st trimester
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 0

Entry 15 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee

status: Final
code: Cigarettes smoked per day by Mother--2nd trimester
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 1

Entry 16 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee

status: Final
code: In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 0

Entry 17 - fullUrl = http://www.example.org/fhir/Observation/observation-number-previous-cesareans-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee

status: Final
code: Previous cesarean deliveries #
subject: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 1

Entry 18 - fullUrl = http://www.example.org/fhir/Condition/condition-gestational-diabetes-carmen-teresa-lee

Resource Condition:

Generated Narrative: Condition condition-gestational-diabetes-carmen-teresa-lee

clinicalStatus: Active
category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]
code: Gestational diabetes mellitus (disorder)
subject: Patient - Mother (Carmen Teresa Lee)
onset: 2018-12-12

Entry 19 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-presentation-not-named

Resource Observation:

Generated Narrative: Observation observation-fetal-presentation-not-named

status: Final
code: Fetal presentation--at birth [US Standard Certificate of Live Birth]
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Breech presentation (finding)

Entry 20 - fullUrl = http://www.example.org/fhir/Procedure/procedure-final-route-method-delivery-not-named

Resource Procedure:

Generated Narrative: Procedure procedure-final-route-method-delivery-not-named

status: Completed
category: Final route and method of delivery [US Standard Certificate of Live Birth]
code: Spontaneous vaginal delivery
subject: Patient - Mother (Carmen Teresa Lee)
performed: 2019-01-19 18:00:00-0700 --> 2019-01-19 18:23:00-0700

Entry 21 - fullUrl = http://www.example.org/fhir/Observation/observation-birth-weight-not-named

Resource Observation:

Generated Narrative: Observation observation-birth-weight-not-named

status: Final
category: Vital Signs
code: Birth weight Measured
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-01-10
performer: Practitioner Janet Seito
value: 1530 g (Details: UCUM codeg = 'g')

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/observation-gestational-age-at-delivery-not-named

Resource Observation:

Generated Narrative: Observation observation-gestational-age-at-delivery-not-named

status: Final
code: Gestational age Estimated
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 20 wk (Details: UCUM codewk = 'wk')

Entry 23 - fullUrl = http://www.example.org/fhir/Condition/condition-fetal-death-cause-or-condition-not-named

Resource Condition:

Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named

category: Encounter Diagnosis, Initiating cause or condition of fetal death [US Standard Report of Fetal Death]
code: Premature rupture of membranes (disorder)
subject: Patient - Decedent Fetus (Fetus Not Named)

Entry 24 - fullUrl = http://www.example.org/fhir/Condition/condition-fetal-death-other-significant-cause-not-named

Resource Condition:

Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named

category: Encounter Diagnosis, Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]
code: Placental insufficiency (disorder)
subject: Patient - Decedent Fetus (Fetus Not Named)

Entry 25 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-death-time-point-not-named

Resource Observation:

Generated Narrative: Observation observation-fetal-death-time-point-not-named

status: Final
code: Estimated timing of fetal death [US Standard Report of Fetal Death]
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Fetal intrapartum death after first assessment (event)

Entry 26 - fullUrl = http://www.example.org/fhir/Observation/observation-autopsy-performed-not-named

Resource Observation:

Generated Narrative: Observation observation-autopsy-performed-not-named

status: Final
code: Autopsy was performed
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Performed

Entry 27 - fullUrl = http://www.example.org/fhir/Observation/observation-histological-placental-exam-performed-not-named

Resource Observation:

Generated Narrative: Observation observation-histological-placental-exam-performed-not-named

status: Final
code: Histological placental examination was performed [US Standard Report of Fetal Death]
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Performed

Entry 28 - fullUrl = http://www.example.org/fhir/Observation/observation-autopsy-histological-exam-results-used-not-named

Resource Observation:

Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named

status: Final
code: Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]
subject: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Yes

Entry 29 - fullUrl = http://www.example.org/fhir/Observation/observation-number-deaths-this-delivery-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-deaths-this-delivery-carmen-teresa-lee

status: Final
code: Number of fetal deaths delivered
subject: Patient - Mother (Carmen Teresa Lee)
focus: Patient - Decedent Fetus (Fetus Not Named)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 1

Entry 30 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee

status: Final
code: Highest level of education Mother
subject: Patient - Decedent Fetus (Fetus Not Named)
focus: Patient - Mother (Carmen Teresa Lee)
effective: 2019-12-02
performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))
value: 9th through 12th grade; no diploma

Entry 31 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-present-job-carmen-teresa-lee

Extension Parental Role: mother
status: Final
code: History of Occupation
subject: null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))
focus: RelatedPerson Carmen Teresa Lee (official)
effective: 2019-01-09 --> (ongoing)
value: Secretary
Components
- Code Value[x]
* History of Occupation industry State Agency

Entry 32 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-tom-yan-lee

Resource Observation:

Generated Narrative: Observation observation-present-job-tom-yan-lee

Extension Parental Role: father
status: Final
code: History of Occupation
subject: null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))
focus: RelatedPerson Tom Yan Lee (official)
effective: 2019-01-09 --> (ongoing)
value: Teaching Assistant
Components
- Code Value[x]
* History of Occupation industry Elementary and Secondary Schools

Entry 33 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-carmen-teresa-lee

status: Final
code: Mother Input Race and Ethnicity
subject: Patient - Mother (Carmen Teresa Lee)
component
code: White
value: true
component
code: Black Or African American
value: true
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: false
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 34 - fullUrl = http://www.example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee

Resource QuestionnaireResponse:

Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee

LinkID Text Definition Answer
QuestionnaireResponse-patients-fetal-death-carmen-lee Questionnaire:Questionnaire - Patient's Worksheet for the Report of Fetal Death

mother-current-legal-name What is your current legal name?

mother-first-name First Carmen

mother-middle-name Middle Teresa

mother-last-name Last Lee

mother-address Where do you usually live - that is - where is your household/residence located?

mother-nbr-street Complete number and street (do not enter rural route numbers) 3670 Miller Road

mother-city City, Town, or Location

mother-state State (or U.S. Territory, Canadian Province) MI

mother-zip Zip Code 48103

inside-city-limits Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)? v2 Y/N Indicator N: No

mother-mail What is your mailing address

mother-mail-same Same as residence [Go to next question] true

mother-dob What is your date of birth? 1986-02-15

mother-birthplace In what State, U.S. territory, or foreign country were you born? Please specify one of the following:

mother-birthplace-territory or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas PR

mother-education What is the highest level of schooling that you have completed at the time of delivery? (Check the box that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received). Education Level SEC: Some secondary or high school education

mother-ethnicity true

mother-ethnicity-mexican true

mother-ethnicity-puerto-rican true

mother-ethnicity-cuban true

mother-ethnicity-other false

mother-race

mother-race-black-or-aa true

father-current-legal-name What is the current legal name of your baby's father?

father-first-name First Tom

father-middle-name Middle Yan

father-last-name Last Lee

father-dob What is the father's date of birth? 1984-02-27

father-birthplace In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:

father-birthplace-state State NY

receive-wic Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy? v2 Y/N Indicator N: No

mothers-height What is your height?

mothers-height-inches Inches 65 [in_i] (Details: UCUM code[in_i] = '[in_i]')

mothers-prepregnancy-weight lbs 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

mothers-smoking How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? If you NEVER smoked, enter zero for each time period.

mothers-smoking-3-months-prior Three months before pregnancy

mothers-smoking-3-months-prior-cig # of cigarettes* 0

mothers-smoking-3-months-prior-pck # of packs 0

mothers-smoking-trimester-1 First three months of pregnancy

mothers-smoking-trimester-1-cig # of cigarettes* 0

mothers-smoking-trimester-1-pck # of packs 0

mothers-smoking-trimester-2 Second three months of pregnancy

mothers-smoking-trimester-2-cig # of cigarettes* 0

mothers-smoking-trimester-2-pck # of packs 0

mothers-smoking-trimester-3 Third trimester of pregnancy

mothers-smoking-trimester-3-cig # of cigarettes* 0

mothers-smoking-trimester-3-pck # of packs 0

Documentation for this format

LinkID	Text	Answer
QuestionnaireResponse-patients-fetal-death-carmen-lee		Questionnaire:Questionnaire - Patient's Worksheet for the Report of Fetal Death
mother-current-legal-name	What is your current legal name?
mother-first-name	First	Carmen
mother-middle-name	Middle	Teresa
mother-last-name	Last	Lee
mother-address	Where do you usually live - that is - where is your household/residence located?
mother-nbr-street	Complete number and street (do not enter rural route numbers)	3670 Miller Road
mother-city	City, Town, or Location
mother-state	State (or U.S. Territory, Canadian Province)	MI
mother-zip	Zip Code	48103
inside-city-limits	Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?	v2 Y/N Indicator N: No
mother-mail	What is your mailing address
mother-mail-same	Same as residence [Go to next question]	true
mother-dob	What is your date of birth?	1986-02-15
mother-birthplace	In what State, U.S. territory, or foreign country were you born? Please specify one of the following:
mother-birthplace-territory	or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas	PR
mother-education	What is the highest level of schooling that you have completed at the time of delivery? (Check the box that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received).	Education Level SEC: Some secondary or high school education
mother-ethnicity		true
mother-ethnicity-mexican		true
mother-ethnicity-puerto-rican		true
mother-ethnicity-cuban		true
mother-ethnicity-other		false
mother-race
mother-race-black-or-aa		true
father-current-legal-name	What is the current legal name of your baby's father?
father-first-name	First	Tom
father-middle-name	Middle	Yan
father-last-name	Last	Lee
father-dob	What is the father's date of birth?	1984-02-27
father-birthplace	In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
father-birthplace-state	State	NY
receive-wic	Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?	v2 Y/N Indicator N: No
mothers-height	What is your height?
mothers-height-inches	Inches	65 [in_i] (Details: UCUM code[in_i] = '[in_i]')
mothers-prepregnancy-weight	lbs	180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')
mothers-smoking	How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? If you NEVER smoked, enter zero for each time period.
mothers-smoking-3-months-prior	Three months before pregnancy
mothers-smoking-3-months-prior-cig	# of cigarettes*	0
mothers-smoking-3-months-prior-pck	# of packs	0
mothers-smoking-trimester-1	First three months of pregnancy
mothers-smoking-trimester-1-cig	# of cigarettes*	0
mothers-smoking-trimester-1-pck	# of packs	0
mothers-smoking-trimester-2	Second three months of pregnancy
mothers-smoking-trimester-2-cig	# of cigarettes*	0
mothers-smoking-trimester-2-pck	# of packs	0
mothers-smoking-trimester-3	Third trimester of pregnancy
mothers-smoking-trimester-3-cig	# of cigarettes*	0
mothers-smoking-trimester-3-pck	# of packs	0
Documentation for this format

Entry 35 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-janet-seito

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-janet-seito

Practitioner Role - Birth Attendant: attendant
Practitioner Role - Certifier: certifier
identifier: NPI/223347044
name: Janet Seito
Qualifications
- Code
* Osteopath (occupation)

Entry 36 - fullUrl = http://www.example.org/fhir/Location/location-south-hospital

Resource Location:

Generated Narrative: Location location-south-hospital

identifier: NPI/116441967701
status: Active
name: South Hospital
type: Hospital, Birth Location
address: 2100 North Ave Salt Lake City UT 84116 US
Positions
- Longitude Latitude
* 40.8 111.9
managingOrganization: Organization - South Hospital

Entry 37 - fullUrl = http://www.example.org/fhir/Organization/organization-south-hospital

Resource Organization:

Generated Narrative: Organization organization-south-hospital

identifier: NPI/5555512
active: true
type: Hospital
name: South Hospital
telecom: +1-555-555-1111, mail@southhospital.com
address: 2100 North Ave Salt Lake City UT 84116 US

Entry 38 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-mother-carmen-teresa-lee

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee

active: true
patient: Patient - Decedent Fetus (Fetus Not Named)
relationship: Gestational Mother
name: Carmen Teresa Lee (Official)
gender: Female
birthDate: 1986-02-15

Entry 39 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-father-natural-tom-yan-lee

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-father-natural-tom-yan-lee

RelatedPerson Birth Place Vital Records: NY
active: true
patient: Patient - Decedent Fetus (Fetus Not Named)
relationship: Natural Father
name: Tom Yan Lee (Official)
gender: Male
birthDate: 1984-02-27

Entry 40 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-jessica-leung

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-jessica-leung

identifier: NPI/223347055
name: Leung Jessica
Qualifications
- Code
* Birth Clerk