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 https://github.com/HL7/fhir-bfdr/ and changes regularly. See the Directory of published versions

Example Bundle: Bundle - Provider Live Birth - Baby G Quinn

Document Details

Generated Narrative: Bundle Provider supplied live birth report Document

Document Subject


Document Content

Prenatal records

Clinical information

Newborn delivery information

Mother's administrative information

Father's administrative information

Questionnaire response Document


Additional Resources Included in Document


Entry 1 - fullUrl = http://www.example.org/fhir/Composition/composition-provider-live-birth-babyg-quinn

Resource Composition:

Generated Narrative: Composition composition-provider-live-birth-babyg-quinn

status: Final

type: U.S. standard certificate of live birth - 2003 revision

encounter: Encounter: extension = No display for Extension ; identifier = http://hospital.smarthealthit.org#9937012; 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 = 2019-02-12 13:00:00-0700 --> 2019-02-15 10:00:00-0700

date: 2019-02-12

author: Practitioner Avery Jones

title: Provider supplied live birth report Document


Entry 2 - fullUrl = http://www.example.org/fhir/Patient/patient-child-babyg-quinn

Resource Patient:

Generated Narrative: Patient patient-child-babyg-quinn

Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))


Deceased:falseMultiple Birth:1
US Core Ethnicity Extension:
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 PlaceSalt Lake City UT
US Core Birth Sex ExtensionF
US Core Race Extension:

Entry 3 - fullUrl = http://www.example.org/fhir/Encounter/encounter-birth-babyg-quinn

Resource Encounter:

Generated Narrative: Encounter encounter-birth-babyg-quinn

Not done yet

Entry 4 - fullUrl = http://www.example.org/fhir/Encounter/encounter-maternity-jada-ann-quinn

Resource Encounter:

Generated Narrative: Encounter encounter-maternity-jada-ann-quinn

Not done yet

Entry 5 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-avery-jones

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-avery-jones

identifier: http://hl7.org/fhir/sid/us-npi/76231001

name: Avery Jones

Qualifications

-Code
*Osteopath (occupation)

Entry 6 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-janet-seito

Resource Practitioner:

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

identifier: http://hl7.org/fhir/sid/us-npi/223347044

name: Janet Seito

Qualifications

-Code
*Osteopath (occupation)

Entry 7 - fullUrl = http://www.example.org/fhir/Patient/patient-mother-jada-ann-quinn

Resource Patient:

Generated Narrative: Patient patient-mother-jada-ann-quinn

Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Social Security number: 132225986 (use: usual, ))


Other Id:Medical Record Number/1032702 (use: usual, )
Alt. Name:Jada Ann King (Name changed for Marriage)
Contact Detail
  • ph: 1-(404)555-1212(Home)
  • jadaann.quinn@example.com
  • 1875 West Morton Avenue Salt Lake City UT 84116 US (home)
  • 1848 South 1300 East Salt Lake City UT 84401 US (billing)
US Core Ethnicity Extension:
Patient Birth PlaceUT
US Core Birth Sex ExtensionF
US Core Race Extension:
  • ombCategory: CDC Race and Ethnicity 1002-5: American Indian or Alaska Native
  • text: White, American Indian or Alaska Native

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-jada-ann-quinn

status: Final

code: Date first prenatal visit

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2018-07-20


Entry 9 - fullUrl = http://www.example.org/fhir/Observation/observation-number-prenatal-visits-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-prenatal-visits-jada-ann-quinn

status: Final

code: Prenatal visits for this pregnancy #

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 8


Entry 10 - fullUrl = http://www.example.org/fhir/Observation/observation-last-menstrual-period-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-last-menstrual-period-jada-ann-quinn

status: Final

code: Last menstrual period start date

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2018-06-05


Entry 11 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-living-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-births-now-living-jada-ann-quinn

status: Final

code: [#] Births.still living

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 1


Entry 12 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-dead-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-births-now-dead-jada-ann-quinn

status: Final

code: Previous live births now dead #

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 0


Entry 13 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-live-birth-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-last-live-birth-jada-ann-quinn

status: Final

code: Date of last live birth

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2014-11-20


Entry 14 - fullUrl = http://www.example.org/fhir/Observation/observation-number-other-pregnancy-outcomes-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-other-pregnancy-outcomes-jada-ann-quinn

status: Final

code: Other pregnancy outcomes #

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 0


Entry 15 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-other-pregnancy-outcome-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-last-other-pregnancy-outcome-jada-ann-quinn

status: Final

code: Date of last other pregnancy outcome

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2015-05


Entry 16 - fullUrl = http://www.example.org/fhir/Coverage/coverage-principal-payer-for-delivery-jada-ann-quinn

Resource Coverage:

Generated Narrative: Coverage coverage-principal-payer-for-delivery-jada-ann-quinn

status: Active

type: Private Health Insurance

beneficiary: Patient - Mother (Jada Ann Quinn)


Entry 17 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-delivery-weight-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-delivery-weight-jada-ann-quinn

status: Final

category: Vital Signs

code: Mother's body weight --at delivery

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-02-12

performer: Practitioner Janet Seito

value: 175 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')


Entry 18 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-height-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-height-jada-ann-quinn

status: Final

category: Vital Signs

code: Body height

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-02-10

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: 67 in (Details: UCUM code[in_i] = '[in_i]')


Entry 19 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-prepregnancy-weight-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-prepregnancy-weight-jada-ann-quinn

status: Final

category: Vital Signs

code: Body weight --pre current pregnancy

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 145 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')


Entry 20 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-received-wic-food-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-received-wic-food-jada-ann-quinn

status: Final

code: Mother WIC food recipient

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Yes


Entry 21 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-1-jada-ann-quinn

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 (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: 20


Entry 22 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-2-jada-ann-quinn

status: Final

code: Cigarettes smoked per day by Mother--1st trimester

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: 3


Entry 23 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-3-jada-ann-quinn

status: Final

code: Cigarettes smoked per day by Mother--2nd trimester

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: 1


Entry 24 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-4-jada-ann-quinn

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 (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: 0


Entry 25 - fullUrl = http://www.example.org/fhir/Condition/condition-prepregnancy-diabetes-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-prepregnancy-diabetes-jada-ann-quinn

clinicalStatus: Active

category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]

code: Diabetes mellitus (disorder)

subject: Patient - Mother (Jada Ann Quinn)

onset: 2015-02-12


Entry 26 - fullUrl = http://www.example.org/fhir/Condition/condition-gestational-hypertension-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-gestational-hypertension-jada-ann-quinn

clinicalStatus: Active

category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]

code: Pregnancy-induced hypertension (disorder)

subject: Patient - Mother (Jada Ann Quinn)


Entry 27 - fullUrl = http://www.example.org/fhir/Observation/observation-number-previous-cesareans-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-previous-cesareans-jada-ann-quinn

status: Final

code: Previous cesarean deliveries #

subject: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 1


Entry 28 - fullUrl = http://www.example.org/fhir/Condition/condition-infection-present-during-pregnancy-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-infection-present-during-pregnancy-jada-ann-quinn

clinicalStatus: Active

category: Problem List Item, Infections present AndOr treated during this pregnancy for live birth [US Standard Certificate of Live Birth]

code: Chlamydial infection (disorder)

subject: Patient - Mother (Jada Ann Quinn)


Entry 29 - fullUrl = http://www.example.org/fhir/Procedure/procedure-obstetric-procedure-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-obstetric-procedure-jada-ann-quinn

status: Completed

category: Obstetric procedures performed [US Standard Certificate of Live Birth]

code: External cephalic version: Failed

subject: Patient - Mother (Jada Ann Quinn)

outcome: External cephalic version: Unsuccessful


Entry 30 - fullUrl = http://www.example.org/fhir/Condition/condition-chorioamnionitis-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-chorioamnionitis-jada-ann-quinn

clinicalStatus: Active

category: Problem List Item, Characteristics of labor and delivery [US Standard Certificate of Live Birth]

code: Chorioamnionitis (disorder)

subject: Patient - Mother (Jada Ann Quinn)


Entry 31 - fullUrl = http://www.example.org/fhir/Procedure/procedure-induction-of-labor-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-induction-of-labor-jada-ann-quinn

status: Completed

category: Characteristics of labor and delivery [US Standard Certificate of Live Birth]

code: Induction of labor (procedure)

subject: Patient - Mother (Jada Ann Quinn)


Entry 32 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-presentation-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-fetal-presentation-babyg-quinn

status: Final

code: Fetal presentation--at birth [US Standard Certificate of Live Birth]

subject: Patient - Child (Baby G Quinn)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Breech presentation (finding)


Entry 33 - fullUrl = http://www.example.org/fhir/Procedure/procedure-final-route-method-delivery-babyg-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-final-route-method-delivery-babyg-quinn

status: Completed

category: Final route and method of delivery [US Standard Certificate of Live Birth]

code: Cesarean section

subject: Patient - Mother (Jada Ann Quinn)


Entry 34 - fullUrl = http://www.example.org/fhir/Condition/condition-ruptured-uterus-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-ruptured-uterus-jada-ann-quinn

clinicalStatus: Active

category: Problem List Item, Maternal morbidity [US Standard Certificate of Live Birth]

code: Rupture of uterus (disorder)

subject: Patient - Mother (Jada Ann Quinn)


Entry 35 - fullUrl = http://www.example.org/fhir/Observation/observation-birth-weight-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-birth-weight-babyg-quinn

status: Final

category: Vital Signs

code: Birth weight Measured

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2500 g (Details: UCUM codeg = 'g')


Entry 36 - fullUrl = http://www.example.org/fhir/Observation/observation-gestational-age-at-delivery-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-gestational-age-at-delivery-babyg-quinn

status: Final

code: Gestational age Estimated

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 36 wk (Details: UCUM codewk = 'wk')


Entry 37 - fullUrl = http://www.example.org/fhir/Observation/observation-apgar-score-babyg-quinn-5-min

Resource Observation:

Generated Narrative: Observation observation-apgar-score-babyg-quinn-5-min

status: Final

category: Survey

code: 5 minute Apgar Score

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 5


Entry 38 - fullUrl = http://www.example.org/fhir/Observation/observation-apgar-score-babyg-quinn-10-min

Resource Observation:

Generated Narrative: Observation observation-apgar-score-babyg-quinn-10-min

status: Final

category: Survey

code: 10 minute Apgar Score

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 7


Entry 39 - fullUrl = http://www.example.org/fhir/Observation/observation-number-live-births-this-delivery-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-live-births-this-delivery-jada-ann-quinn

status: Final

code: Number of infants in this delivery delivered alive

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2


Entry 40 - fullUrl = http://www.example.org/fhir/Condition/condition-congenital-anomaly-of-newborn-babyg-quinn

Resource Condition:

Generated Narrative: Condition condition-congenital-anomaly-of-newborn-babyg-quinn

clinicalStatus: Active

category: Problem List Item, Congenital anomalies of the newborn [US Standard Certificate of Live Birth]

code: Cyanotic congenital heart disease (disorder)

subject: BabyG Quinn


Entry 41 - fullUrl = http://www.example.org/fhir/Condition/condition-congenital-anomaly-of-newborn-babyg-quinn-2

Resource Condition:

Generated Narrative: Condition condition-congenital-anomaly-of-newborn-babyg-quinn-2

clinicalStatus: Active

category: Problem List Item, Congenital anomalies of the newborn [US Standard Certificate of Live Birth]

code: Anomaly of chromosome pair 21 (disorder)

subject: Patient - Child (Baby G Quinn)

evidence


Entry 42 - fullUrl = http://www.example.org/fhir/Observation/observation-infant-living-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-infant-living-babyg-quinn

status: Final

code: Infant living at time of report [US Standard Certificate of Live Birth]

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: true


Entry 43 - fullUrl = http://www.example.org/fhir/Observation/observation-infant-breastfed-at-discharge-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-infant-breastfed-at-discharge-babyg-quinn

status: Final

code: Infant is being breastfed at discharge [US Standard Certificate of Live Birth]

subject: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: true


Entry 44 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-married-during-pregnancy-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-married-during-pregnancy-jada-ann-quinn

status: Final

code: Mother was married at any time during pregnancy

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

value: Yes


Entry 45 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-jada-ann-quinn

status: Final

code: Highest level of education Mother

subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))

focus: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: Doctoral or post graduate education


Entry 46 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-present-job-jada-ann-quinn

status: Final

code: History of Occupation

subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))

focus: Jada Ann Quinn - Mother

effective: 2019-01-09 --> (ongoing)

value: Carpenter

Components

-CodeValue[x]
*History of Occupation industryConstruction

Entry 47 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-jada-ann-quinn

status: Final

code: Mother Input Race and Ethnicity

subject: Patient - Mother (Jada Ann Quinn)

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: Hispanic Mexican

value: No

component

code: Hispanic Cuban

value: No

component

code: Hispanic Puerto Rican

value: No

component

code: Hispanic Other

value: No


Entry 48 - fullUrl = http://www.example.org/fhir/Observation/observation-ssn-requested-for-child-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-ssn-requested-for-child-babyg-quinn

status: Final

code: Social Security Number was requested

subject: BabyG Quinn

focus: Patient - Mother (Jada Ann Quinn)

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: true


Entry 49 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-father-natural-james-brandon-quinn

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-father-natural-james-brandon-quinn

identifier: Social Security number/132225987

active: true

patient: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))

relationship: Natural Father

name: James Brandon Quinn (Official)

gender: Male

birthDate: 1972-11-24


Entry 50 - fullUrl = http://www.example.org/fhir/Observation/observation-paternity-acknowledgement-signed-james-quinn

Resource Observation:

Generated Narrative: Observation observation-paternity-acknowledgement-signed-james-quinn

status: Final

code: Paternity acknowledgment form signed Father

subject: Patient - Child (Baby G Quinn)

focus: RelatedPerson - Father (James Brandon Quinn)

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: Yes


Entry 51 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-james-quinn

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-james-quinn

status: Final

code: Highest level of education Father

subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))

focus: RelatedPerson James Brandon Quinn (official)

effective: 2019-12-02

performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))

value: Doctoral or post graduate education


Entry 52 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-james-brandon-quinn

Resource Observation:

Generated Narrative: Observation observation-present-job-james-brandon-quinn

status: Final

code: History of Occupation

subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))

focus: James Brandon Quinn - Father

effective: 2019-01-09 --> (ongoing)

value: Lawyer

Components

-CodeValue[x]
*History of Occupation industryLegal Services

Entry 53 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-james-quinn

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-james-quinn

status: Final

code: Father Input Race and Ethnicity

subject: BabyG Quinn

focus: RelatedPerson James Brandon Quinn (official)

component

code: White

value: true

component

code: Black Or African American

value: false

component

code: American Indian Or Alaska Native

value: false

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: No

component

code: Hispanic Cuban

value: No

component

code: Hispanic Puerto Rican

value: No

component

code: Hispanic Other

value: No


Entry 54 - fullUrl = http://www.example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-mothers-live-birth-jada-quinn

Resource QuestionnaireResponse:

Generated Narrative: QuestionnaireResponse QuestionnaireResponse-mothers-live-birth-jada-quinn

LinkIDTextDefinitionAnswerdoco
.. QuestionnaireResponse-mothers-live-birth-jada-quinnQuestionnaire:Questionnaire - Mother's Worksheet for Child's Birth Certificate
... mother-current-legal-nameWhat is your current legal name?
.... mother-first-nameFirstJada
.... mother-middle-nameMiddleAnn
.... mother-last-nameLastQuinn
... child-nameWhat will be your baby's legal name (as it should appear on the birth certificate)?
.... child-first-nameFirstBaby
.... child-middle-nameMiddleG
.... child-last-nameLastQuinn
... mother-addressWhere do you usually live - that is - where is your household/residence located?
.... mother-nbr-streetComplete number and street (do not enter rural route numbers)1875 West Morton Avenue
.... mother-cityCity, Town, or LocationSalt Lake City
.... mother-countyCountySalt Lake
.... mother-stateState (or U.S. Territory, Canadian Province)UT
.... mother-zipZip Code84116
... inside-city-limitsIs this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?v2 Y/N Indicator Y: Yes
... mother-mailWhat is your mailing address
.... mother-mail-sameSame as residence [Go to next question]false
.... mother-mail-nbr-streetComplete number and street1848 South 1300 East
.... mother-mail-cityCity, Town, or LocationSalt Lake City
.... mother-mail-stateState (or U.S. Territory, Canadian Province)UT
.... mother-mail-zipZip Code84401
... mother-dobWhat is your date of birth?1985-01-15
... mother-birthplaceIn what State, U.S. territory, or foreign country were you born? Please specify one of the following:
.... mother-birthplace-stateStateUT
... mother-educationWhat 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 POSTG: Doctoral or post graduate education
... mother-ethnicityfalse
... mother-race
.... mother-race-whiteWhitetrue
.... mother-race-aianAmerican Indian or Alaskan Nativetrue
... receive-wicDid you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?v2 Y/N Indicator Y: Yes
... infertility-treatmentDid this pregnancy result from infertility treatment? (If yes, please answer 12a and 12b)true
.... drugs-ai-iiIf yes, did this pregnancy result from fertility-enhancing drugs, artificial insemination, or intrauterine insemination?false
.... art-ivf-giftIf yes, did this pregnancy result from assisted reproductive technology (e.g., in-vitro fertilization (IVF), gamete intrafallopian transfer (GIFT))?true
... mothers-heightWhat is your height?
.... mothers-height-feetFeet5 ft (Details: UCUM codeft = 'ft')
.... mothers-height-inchesInches7 [in_i] (Details: UCUM code[in_i] = '[in_i]')
... mothers-prepregnancy-weight145 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')
... mothers-smokingHow 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-priorThree months before pregnancy
..... mothers-smoking-3-months-prior-cig# of cigarettes*0
..... mothers-smoking-3-months-prior-pck# of packs1
.... mothers-smoking-trimester-1First three months of pregnancy
..... mothers-smoking-trimester-1-cig# of cigarettes*3
..... mothers-smoking-trimester-1-pck# of packs0
.... mothers-smoking-trimester-2Second three months of pregnancy
..... mothers-smoking-trimester-2-cig# of cigarettes*1
..... mothers-smoking-trimester-2-pck# of packs0
.... mothers-smoking-trimester-3Third trimester of pregnancy
..... mothers-smoking-trimester-3-cig# of cigarettes*0
..... mothers-smoking-trimester-3-pck# of packs0
... mother-prior-nameWhat name did you use prior to your first marriage?
.... mother-prior-first-nameFirstJada
.... mother-prior-middle-nameMiddleAnn
.... mother-prior-last-nameLastKing
... married-conceptionWere you married at the time you conceived this child, at the time of birth, or at any time between conception and giving birth? [If yes, please go to question 19; If no, please see below]true
... father-current-legal-nameWhat is the current legal name of your baby's father?
.... father-first-nameFirstJames
.... father-middle-nameMiddleBrandon
.... father-last-nameLastQuinn
... father-dobWhat the father's date of birth?1983-09-27
... father-birthplaceIn what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
.... father-birthplace-stateStateNY
... father-educationWhat is the highest level of schooling that the father will have completed at the time of delivery? (Check the box that best describes his education. If he is currently enrolled, check the box that indicates the previous grade or highest degree received).Education Level POSTG: Doctoral or post graduate education
... father-ethnicityfalse
... father-race
.... father-race-whiteWhitetrue
... parents-ssnFurnishing parent(s) Social Security Number(s) (SSNs) is required by Federal Law, 42 USC 405(c) (section 205(c) of the Social Security Act). The number(s) will be made available to the (State Social Services Agency) to assist with child support enforcement activities and to the Internal Revenue Service for the purpose of determining Earned Income Tax Credit compliance.
.... mother-ssnWhat is your Social Security Number?132-22-5986
.... father-ssnWhat is the father’s Social Security Number? If you are not married, and if a paternity acknowledgment has not been completed, leave this item blank.132-22-5987
... baby-ssnDo you want a Social Security Number issued for your baby? [If yes, please sign request belowfalse
... informant-nameIf other than the mother, what is the name of the person providing information for this worksheet?
.... informant-first-nameFirstJane
.... informant-last-nameLastKing
... informant-relationshipWhat is your relationship to the baby's mother?Local BFDR Codes rel_otherrelative: Other relative

doco Documentation for this format

Entry 55 - fullUrl = http://www.example.org/fhir/Location/location-east-hospital

Resource Location:

Generated Narrative: Location location-east-hospital

status: Active

name: East Hospital

type: Hospital, Transfer-to Location


Entry 56 - fullUrl = http://www.example.org/fhir/Location/location-south-hospital

Resource Location:

Generated Narrative: Location location-south-hospital

identifier: http://hl7.org/fhir/sid/us-npi/116441967701

status: Active

name: South Hospital

type: Hospital, Birth Location

address: 2100 North Ave Salt Lake City UT 84116 US

Positions

-LongitudeLatitude
*40.8111.9

managingOrganization: Organization - South Hospital


Entry 57 - fullUrl = http://www.example.org/fhir/Location/location-north-hospital

Resource Location:

Generated Narrative: Location location-north-hospital

status: Active

name: North Hospital

type: Hospital, Transfer-from Location


Entry 58 - fullUrl = http://www.example.org/fhir/Organization/organization-south-hospital

Resource Organization:

Generated Narrative: Organization organization-south-hospital

identifier: http://hl7.org/fhir/sid/us-npi/5555512

active: true

type: Hospital

name: South Hospital

contact

telecom: +1-555-555-1111, mail@southhospital.com

address: 2100 North Ave Salt Lake City UT 84116 US


Entry 59 - fullUrl = http://www.example.org/fhir/Observation/observation-labor-trial-attempted-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-labor-trial-attempted-babyg-quinn

status: Final

code: If cesarean, a trial of labor was attempted [US Standard Certificate of Live Birth]

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: true


Entry 60 - fullUrl = http://www.example.org/fhir/Procedure/procedure-infertility-treatment-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-infertility-treatment-jada-ann-quinn

status: Completed

category: Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]

code: Fertility enhancing drug therapy (procedure)

subject: Patient - Mother (Jada Ann Quinn)


Entry 61 - fullUrl = http://www.example.org/fhir/Procedure/procedure-artificial-insemination-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-artificial-insemination-jada-ann-quinn

version: versionId: id (PrimitiveType/Bundle.entry[60].resource.meta.versionId): native = id -> 1; Last updated: 2023-06-21 01:45:22+0000

Profile: Procedure - Artificial Insemination

status: Completed

category: Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]

code: Artificial insemination (procedure)

subject: Patient - Mother (Jada Ann Quinn)


Entry 62 - fullUrl = http://www.example.org/fhir/Observation/observation-antibiotics-during-labor-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-antibiotics-during-labor-jada-ann-quinn

status: Final

code: Characteristics of labor and delivery

subject: Patient - Mother (Jada Ann Quinn)

focus: BabyG Quinn

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Antibiotics received during labor


Entry 63 - fullUrl = http://www.example.org/fhir/Procedure/procedure-antibiotic-sepsis-babyg-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-antibiotic-sepsis-babyg-quinn

status: Completed

category: Abnormal conditions of the newborn [US Standard Certificate of Live Birth]

code: Antibiotic given for suspected neonatal sepsis (situation)

subject: BabyG Quinn


Entry 64 - fullUrl = http://www.example.org/fhir/Procedure/procedure-epidural-or-spinal-anesthesia-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-epidural-or-spinal-anesthesia-jada-ann-quinn

status: Completed

category: Characteristics of labor and delivery [US Standard Certificate of Live Birth]

code: Epidural anesthesia (procedure)

subject: Patient - Mother (Jada Ann Quinn)