Birth And Fetal Death (BFDR) - STU2-ballot
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Birth And Fetal Death (BFDR) - STU2-ballot, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0-Preview1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

Birth and Fetal Death Reporting Home

Official URL: Version: 2.0.0-Preview1
Active as of 2024-06-11 Computable Name: BirthAndFetalDeath
Other Identifiers: OID:2.16.840.1.113883.4.642.40.13



Birth and fetal death reporting includes the transmission of data from health care providers to jurisdictional vital records offices (VROs) and from VROs to the CDC National Center for Health Statistics (NCHS). Data associated with the mother of the baby or delivered fetus may be communicated independently from data associated directly with the labor and delivery encounter at the responsible healthcare facility. Note that for the purposes of this guide, "mother" always refers to the woman who delivered the infant or fetus. In cases of surrogacy or gestational carrier, the information reported should be for the surrogate or the gestational carrier, that is, the woman who delivered the infant.

This implementation guide (IG) defines a series of Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) profiles on the Composition resource to represent electronic birth and fetal death reporting (BFDR). It includes the content of medical/health information on live births and fetal deaths for select state and federal birth and fetal death reporting, as indicated in the 2003 Revision of the U.S. Standard Certificate of Live Birth and the 2003 Revision of the U.S. Standard Report of Fetal Death. Additionally, it includes the content that is exchanged between electronic health record (EHR) systems, VROs and NCHS.

The STU2 version of the Birth and Fetal Death Reporting (BFDR) IG was focused on enabling submission of records from Electronic Birth Registration Systems hosted by Vital Records Organizations (VROs) to the Center for Disease Control (CDC) National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). This involved the addition of profiles supporting NCHS-standard submission of race and ethnicity inputs, and return of coded race and ethnicity. These profiles are referenced in BFDR, but defined in the Vital Records Common Library (VRCL) IG. Content (i.e., profiles, valuesets, examples) that is used exclusively in the birth and fetal death use cases was moved from VRCL to the BFDR. As a result, the total content of this IG has dramatically increased in size. Valuesets formerly hosted in PHINVADs have been included within the IG, and are referenced in valueset descriptions. This follows the pattern established by the VRDR IG.

For a description of the changes to BFDR from STU1.1, see the Change table.

Relationship to Other Standards

This BFDR IG standard complements other vital records standards to support the expansion of information flows to and from the national statistics agency. The BFDR STU 1 drew on foundational work of early standards listed in the Background section, below. This current version of the BFDR IG is informed by :


This implementation guide re-uses and further constrains profiles from the following guides:


This guide is for analysts and developers who require guidance on the use of the HL7 FHIR for providing birth and fetal death reporting information. The IG is informative to health care provider organizations, jurisdictional vital records offices, CDC/NCHS, health information exchange organizations, and other vital records fetal death reporting stakeholders.


This FHIR IG builds on previous electronic data standards for transmitting vital records of death, birth, and fetal death.

This IG provides standardized data strutures for transmission of reliable and relevant clinical information to jurisdictional vital records offices and transfer of information from vital records offices to the national statistics agency.

Electronic vital records work started with the HL7 Vital Records Domain Analysis Model (VR DAM), published as an Informative Specification in 2011. The VR DAM was updated in 2017 with the HL7 Cross-Paradigm Domain Analysis Model: Vital Records, Release 2, in 2018, with Release 3, and in November 2020 as Release 4. VR DAM, Release 5 was published in May 2022. Implementers who review or reference the VR DAM should note that the active vital records FHIR IGs (such as BFDR and VRDR) may no longer aligned with the VR DAM.

This FHIR IG uses the US Core profiles. Where this FHIR IG is unable to use a US Core profile, we have followed the Cross Group Projects Work Group’s variance request process, and have provided the US Realm Steering Committee an approved rationale for deviation in the IG.

How to Read This Guide

This Guide is divided into several pages which are listed at the top of each page in the menu bar.

Other Information

This guide is compliant with FHIR Release 4.

For Clinical Safety Information please refer to the FHIR Implementer’s Safety Checklist.

Disclaimer: All proprietary documents, guides, guidance, standards, codes, and values contained herein remain the property of their respective Standards Developing Organization (SDO). HL7 does not make any claim to ownership herein.


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