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
Death Certificate for Davis Lineberry Jr
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)
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)
Death certification and verification by physician (procedure)
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)
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)
Generated Narrative: RelatedPerson MotherUT-Example1 active: true patient: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number) relationship: mother name: * * * (Official)
Generated Narrative: RelatedPerson FatherUT-Example1 active: true patient: Davis Lineberry (official) Male, DoB: 2021-03-04 ( Social Security number) relationship: father name: * * Lineberry (Official)
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
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
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
Highest level of education [US Standard Certificate of Death]
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
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
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
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
Generated Narrative: Organization FuneralHomeUT-Example1 active: true type: Funeral Home name: Colonial Memorial Mortuary address: 2128 South State Salt Lake City UT 84115 US
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
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
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
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
Generated Narrative: Location DeathLocationUT-Example1 name: Salt Lake Regional Medical Cen description: Facility type: Death Location address: Salt Lake City UT
Generated Narrative: Location DispositionLocationUT-Example1 name: Salt Lake City Cemetery type: Disposition Location address: Salt Lake City UT US
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
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')
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
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