Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/DeathCertificateUT-Example1

Resource Composition:

Generated Narrative: Composition DeathCertificateUT-Example1

Filing Format: Electronic

State Specific Field: 20220101

status: Final

type: Death certificate

date: 2022-12-01 02:46:13-0500

author: Practitioner William Henry Harrison (official)

title: Death Certificate for Davis Lineberry Jr

Attesters

-	Mode	Party
*	Legal	Practitioner William Henry Harrison (official)

Events

-	Code	Detail
*	Death certificate (record artifact)	Procedure Death certification

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/DecedentUT-Example1

Resource Patient:

Generated Narrative: Patient DecedentUT-Example1

Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

---

Marital Status:	Never Married
Contact Detail	2722 N Pin Oak Dr Laramie WY 82070 US
NVSS SexAtDeath	Male
Patient Birth Place	CO US (old)

Entry 3 - fullUrl = http://www.example.org/fhir/Procedure/ProcedureDeathCertificationUT-Example1

Resource Procedure:

Generated Narrative: Procedure ProcedureDeathCertificationUT-Example1

identifier: 161632-1999

status: Completed

code: Death certification

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

performed: 2021-11-14 16:39:40-0500

Performers

-	Function	Actor
*	Death certification and verification by physician (procedure)	Practitioner William Henry Harrison (official)

Entry 4 - fullUrl = http://www.example.org/fhir/Practitioner/PractitionerUT-Certifier

Resource Practitioner:

Generated Narrative: Practitioner PractitionerUT-Certifier

Practitioner Role: Certifier

identifier: NPI/161632-1999

name: William Henry Harrison (Official)

address: 123 Fake St apt # 123 Salt Lake UT 84111 US (work)

Entry 5 - fullUrl = http://www.example.org/fhir/Practitioner/PractitionerUT-Pronouncer

Resource Practitioner:

Generated Narrative: Practitioner PractitionerUT-Pronouncer

identifier: NPI/161632-2000

name: Marcus Edwin Welby (Official)

address: 123 Unreal St apt # 123 Ogden UT 84067 US (work)

Entry 6 - fullUrl = http://www.example.org/fhir/RelatedPerson/MotherUT-Example1

Resource RelatedPerson:

Generated Narrative: RelatedPerson MotherUT-Example1

active: true

patient: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

relationship: mother

name: * * * (Official)

Entry 7 - fullUrl = http://www.example.org/fhir/RelatedPerson/FatherUT-Example1

Resource RelatedPerson:

Generated Narrative: RelatedPerson FatherUT-Example1

active: true

patient: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

relationship: father

name: * * Lineberry (Official)

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/InputRaceAndEthnicityUT-Example1

Resource Observation:

Generated Narrative: Observation InputRaceAndEthnicityUT-Example1

status: Final

code: Input Race and Ethnicity

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

component

code: White

value: true

component

code: Black Or African American

value: false

component

code: American Indian Or Alaska Native

value: true

component

code: First American Indian Or Alaska Native Literal

value: Cheyenne

component

code: Chinese

value: false

component

code: Japanese

value: false

component

code: Native Hawaiian

value: false

component

code: Filipino

value: false

component

code: Other Asian

value: false

component

code: Asian Indian

value: false

component

code: Korean

value: false

component

code: Samoan

value: false

component

code: Vietnamese

value: false

component

code: Guamanian Or Chamorro

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 9 - fullUrl = http://www.example.org/fhir/Observation/BirthRecordIdentifierUT-Example1

Resource Observation:

Generated Narrative: Observation BirthRecordIdentifierUT-Example1

status: Final

code: Birth Record Identifier of Child

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: 001023

component

code: Birthplace

value: CO

component

code: Birth year

value: 2021

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/EducationUT-Example1

Resource Observation:

Generated Narrative: Observation EducationUT-Example1

status: Final

code: Highest level of education [US Standard Certificate of Death]

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: Elementary School

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/PregnancyUT-Example1

Resource Observation:

Generated Narrative: Observation PregnancyUT-Example1

status: Final

code: Timing of recent pregnancy in relation to death

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: Not applicable

Entry 12 - fullUrl = http://www.example.org/fhir/Observation/AutopsyPerformedIndicatorUT-Example1

Resource Observation:

Generated Narrative: Observation AutopsyPerformedIndicatorUT-Example1

status: Final

code: Autopsy was performed

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: Unknown

Components

-	Code	Value[x]
*	Autopsy results available	Unknown

Entry 13 - fullUrl = http://www.example.org/fhir/Observation/CauseOfDeathPart1UT-Example1

Resource Observation:

Generated Narrative: Observation CauseOfDeathPart1UT-Example1

status: Preliminary

code: Cause of death [US Standard Certificate of Death]

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

performer: Practitioner William Henry Harrison (official)

value: Pending

component

code: line number

value: 1

component

code: Disease onset to death interval

value: Pending

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/DeathDateUT-Example1

Resource Observation:

Generated Narrative: Observation DeathDateUT-Example1

status: Final

code: Date and time of death [TimeStamp]

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

effective: 2022-01-17 20:23:00-0500

performer: Practitioner Marcus Edwin Welby (official)

value: Partial Date Time Vital Records:

Components

-	Code	Value[x]
*	Location of death	Death in hospital

Entry 15 - fullUrl = http://www.example.org/fhir/Organization/FuneralHomeUT-Example1

Resource Organization:

Generated Narrative: Organization FuneralHomeUT-Example1

active: true

type: Funeral Home

name: Colonial Memorial Mortuary

address: 2128 South State Salt Lake City UT 84115 US

Entry 16 - fullUrl = http://www.example.org/fhir/Observation/MannerOfDeathUT-Example1

Resource Observation:

Generated Narrative: Observation MannerOfDeathUT-Example1

status: Final

code: Manner of death

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

performer: Practitioner William Henry Harrison (official)

value: Patient awaiting investigation

Entry 17 - fullUrl = http://www.example.org/fhir/Observation/TobaccoUseUT-Example1

Resource Observation:

Generated Narrative: Observation TobaccoUseUT-Example1

status: Final

code: Did tobacco use contribute to death

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: No

Entry 18 - fullUrl = http://www.example.org/fhir/Observation/InjuryIncidentUT-Example1

Resource Observation:

Generated Narrative: Observation InjuryIncidentUT-Example1

status: Final

code: Injury incident description Narrative

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

Components

-	Code	Value[x]
*	Did death result from injury at work	Unknown

Entry 19 - fullUrl = http://www.example.org/fhir/Observation/EmergingIssuesUT-Example1

Resource Observation:

Generated Narrative: Observation EmergingIssuesUT-Example1

status: Final

code: Emerging Issues

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

Components

-	Code	Value[x]
*	EmergingIssue20	043-A-110234

Entry 20 - fullUrl = http://www.example.org/fhir/Location/DeathLocationUT-Example1

Resource Location:

Generated Narrative: Location DeathLocationUT-Example1

name: Salt Lake Regional Medical Cen

description: Facility

type: Death Location

address: Salt Lake City UT

Entry 21 - fullUrl = http://www.example.org/fhir/Location/DispositionLocationUT-Example1

Resource Location:

Generated Narrative: Location DispositionLocationUT-Example1

name: Salt Lake City Cemetery

type: Disposition Location

address: Salt Lake City UT US

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/MilitaryServiceUT-Example1

Resource Observation:

Generated Narrative: Observation MilitaryServiceUT-Example1

status: Final

code: Military service Narrative

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: No

Entry 23 - fullUrl = http://www.example.org/fhir/Observation/AgeUT-Example1

Resource Observation:

Generated Narrative: Observation AgeUT-Example1

status: Final

code: Age at death

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: 10 Months (Details: UCUM codemo = 'mo')

Entry 24 - fullUrl = http://www.example.org/fhir/Observation/UsualWorkUT-Example1

Resource Observation:

Generated Narrative: Observation UsualWorkUT-Example1

status: Final

code: History of Usual occupation

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: Infant

Components

-	Code	Value[x]
*	History of Usual industry	Never Worked

Entry 25 - fullUrl = http://www.example.org/fhir/Observation/DispositionMethodUT-Example1

Resource Observation:

Generated Narrative: Observation DispositionMethodUT-Example1

status: Final

code: Body disposition method

subject: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number)

value: Burial