Generated Narrative: Composition composition-provider-fetal-death-not-named Profile: Composition - Provider Fetal Death Report 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
U.S. standard report of fetal death - 2003 revision
Generated Narrative: Patient patient-decedent-fetus-not-named Profile: Patient - Decedent Fetus null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, )) Deceased: true Multiple Birth: 3 <td style="background-color: #f3f5da" title="This Extension profile represents the reported age of the parent (either the gestational mother or the natural father - as defined by NCHS) at the delivery time of the newborn or fetus. #xA;A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (**US Core Patient Profile** or **US Core RelatedPerson Profile**).">Reported Parent Age At Delivery Vital Records: reportedAge: 34 a (Details: UCUM codea = 'a') motherOrFather: mother <td style="background-color: #f3f5da" title="This Extension profile represents the reported age of the parent (either the gestational mother or the natural father - as defined by NCHS) at the delivery time of the newborn or fetus. #xA;A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (**US Core Patient Profile** or **US Core RelatedPerson Profile**).">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
Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee Profile: Encounter - Maternity 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)
Under Observation or Inpatient Care Services (Including Admission and Discharge Services)
Practitioner - Vital Records (Janet Seito, DO)
Location - US Core Location (South Hospital)
Organization - US Core Organization (South Hospital Organization)
Generated Narrative: Patient patient-mother-carmen-teresa-lee Profile: Patient - Mother Vital Records 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) <td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the [CDC ethnicity and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.">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 <td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:#xA;#xA; - American Indian or Alaska Native#xA; - Asian#xA; - Black or African American#xA; - Native Hawaiian or Other Pacific Islander#xA; - White.">US Core Race Extension: ombCategory: CDC Race and Ethnicity 2054-5: Black or African American text: Black or African America
Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee Profile: Observation - Date of First Prenatal Care Visit 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
Patient - Decedent Fetus (Fetus Not Named)
Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee Profile: Observation - Last Menstrual Period 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
Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee Profile: Observation - Number of Births Now Living status: Final code: [#] Births.still living subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Janet Seito value: 1
Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee Profile: Observation - Number of Births Now Dead status: Final code: Previous live births now dead # subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Janet Seito value: 0
Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee Profile: Observation - Date of Last Live Birth 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
Generated Narrative: Observation observation-mother-height-carmen-teresa-lee Profile: Observation - Mother Height 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]')
Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee Profile: Observation - Mother Prepregnancy Weight 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]')
Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee Profile: Observation - Mother Recieved WIC Food 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
Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee Profile: Observation - Cigarette Smoking Before and During Pregnancy 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
In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]
Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee Profile: Observation - Cigarette Smoking Before and During Pregnancy 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
Cigarettes smoked per day by Mother--1st trimester
Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee Profile: Observation - Cigarette Smoking Before and During Pregnancy 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
Cigarettes smoked per day by Mother--2nd trimester
Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee Profile: Observation - Cigarette Smoking Before and During Pregnancy 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
In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]
Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee Profile: Observation - Number of Previous Cesareans status: Final code: Previous cesarean deliveries # subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Janet Seito value: 1
Generated Narrative: Condition condition-gestational-diabetes-carmen-teresa-lee Profile: Condition - Gestational Diabetes 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
Gestational diabetes mellitus (disorder)
Generated Narrative: Observation observation-fetal-presentation-not-named Profile: Observation - Fetal Presentation at Birth/Delivery 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)
Generated Narrative: Procedure procedure-final-route-method-delivery-not-named Profile: Procedure - Final Route and Method of Delivery 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
Generated Narrative: Observation observation-birth-weight-not-named Profile: Observation - Birth Weight 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')
Generated Narrative: Observation observation-gestational-age-at-delivery-not-named Profile: Observation - Gestational Age at Delivery 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')
Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named Profile: Condition - Fetal Death Initiating Cause or Condition 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)
Initiating cause or condition of fetal death [US Standard Report of Fetal Death]
Premature rupture of membranes (disorder)
Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named Profile: Condition - Fetal Death Other Cause or Condition 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)
Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]
Generated Narrative: Observation observation-fetal-death-time-point-not-named Profile: Observation - Fetal Death Time Point 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)
Fetal intrapartum death after first assessment (event)
Generated Narrative: Observation observation-autopsy-performed-not-named Profile: Observation - Autopsy Performed Indicator status: Final code: Autopsy was performed subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Janet Seito value: Performed
Generated Narrative: Observation observation-histological-placental-exam-performed-not-named Profile: Observation - Histological Placental Exam Performed 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
Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named Profile: Observation - Autopsy or Histological Exam Results Used 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
Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]
Generated Narrative: Observation observation-number-deaths-this-delivery-carmen-teresa-lee Profile: Observation - Number of Fetal Deaths This Delivery 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
Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee Profile: Observation - Education Level Vital Records 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
Generated Narrative: Observation observation-present-job-carmen-teresa-lee Profile: Observation - Present Job 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
Generated Narrative: Observation observation-present-job-tom-yan-lee Profile: Observation - Present Job 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
Generated Narrative: Observation observation-input-race-and-ethnicity-carmen-teresa-lee Profile: Observation - Input Race and Ethnicity Vital Records 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
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 #xD; mother-current-legal-name What is your current legal name? #xD; mother-first-name First Carmen #xD; mother-middle-name Middle Teresa #xD; mother-last-name Last Lee #xD; mother-address Where do you usually live - that is - where is your household/residence located? #xD; mother-nbr-street Complete number and street (do not enter rural route numbers) 3670 Miller Road #xD; mother-city City, Town, or Location #xD; mother-state State (or U.S. Territory, Canadian Province) MI #xD; mother-zip Zip Code 48103 #xD; 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 #xD; mother-mail What is your mailing address #xD; mother-mail-same Same as residence [Go to next question] true #xD; mother-dob What is your date of birth? 1986-02-15 #xD; mother-birthplace In what State, U.S. territory, or foreign country were you born? Please specify one of the following: #xD; mother-birthplace-territory or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas PR #xD; 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 #xD; mother-ethnicity true #xD; mother-ethnicity-mexican true #xD; mother-ethnicity-puerto-rican true #xD; mother-ethnicity-cuban true #xD; mother-ethnicity-other false #xD; mother-race #xD; mother-race-black-or-aa true #xD; father-current-legal-name What is the current legal name of your baby's father? #xD; father-first-name First Tom #xD; father-middle-name Middle Yan #xD; father-last-name Last Lee #xD; father-dob What is the father's date of birth? 1984-02-27 #xD; father-birthplace In what State, U.S. territory, or foreign country was the father born? Please specify one of the following: #xD; father-birthplace-state State NY #xD; receive-wic Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy? v2 Y/N Indicator N: No #xD; mothers-height What is your height? #xD; mothers-height-inches Inches 65 [in_i] (Details: UCUM code[in_i] = '[in_i]') #xD; mothers-prepregnancy-weight lbs 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]') #xD; 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. #xD; mothers-smoking-3-months-prior Three months before pregnancy #xD; mothers-smoking-3-months-prior-cig # of cigarettes* 0 #xD; mothers-smoking-3-months-prior-pck # of packs 0 #xD; mothers-smoking-trimester-1 First three months of pregnancy #xD; mothers-smoking-trimester-1-cig # of cigarettes* 0 #xD; mothers-smoking-trimester-1-pck # of packs 0 #xD; mothers-smoking-trimester-2 Second three months of pregnancy #xD; mothers-smoking-trimester-2-cig # of cigarettes* 0 #xD; mothers-smoking-trimester-2-pck # of packs 0 #xD; mothers-smoking-trimester-3 Third trimester of pregnancy #xD; mothers-smoking-trimester-3-cig # of cigarettes* 0 #xD; mothers-smoking-trimester-3-pck # of packs 0 #xD; Documentation for this format
Where do you usually live - that is - where is your household/residence located?
Complete number and street (do not enter rural route numbers)
State (or U.S. Territory, Canadian Province)
Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?
In what State, U.S. territory, or foreign country were you born? Please specify one of the following:
or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas
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).
What is the current legal name of your baby's father?
In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?
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.
Generated Narrative: Practitioner practitioner-vital-records-janet-seito Profile: Practitioner - Vital Records Practitioner Role - Birth Attendant: attendant Practitioner Role - Certifier: certifier identifier: NPI/223347044 name: Janet Seito Qualifications - Code * Osteopath (occupation)
Generated Narrative: Location location-south-hospital Profile: Birth and Fetal Death Location 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
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
Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee Profile: RelatedPerson - Mother Vital Records active: true patient: Patient - Decedent Fetus (Fetus Not Named) relationship: Gestational Mother name: Carmen Teresa Lee (Official) gender: Female birthDate: 1986-02-15
Generated Narrative: RelatedPerson relatedperson-father-natural-tom-yan-lee Profile: RelatedPerson - Father Natural Vital Records 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
Generated Narrative: Practitioner practitioner-vital-records-jessica-leung Profile: Practitioner - Vital Records identifier: NPI/223347055 name: Leung Jessica Qualifications - Code * Birth Clerk