Vital Records Death Reporting (VRDR) FHIR Implementation Guide
3.0.0 - STU3

Vital Records Death Reporting (VRDR) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 3.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/QRPH.VRDR/ and changes regularly. See the Directory of published versions

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Decedent Demographics

Demographic data includes information about related persons (Mother, Father, and Spouse) and social determinants such as education level. The information in this profile group are provided by a decedent informant.

Decedent | Decedent (PatientVitalRecords)
Decedent Age | The Decedent Age (Observation) profile provides the decedent's chronological age at the time of death.
Decedent Education Level | Decedent Education Level (ObservationEducationLevelVitalRecords)
Decedent Mother | Decedent Mother (RelatedPersonParentVitalRecords)
Decedent Father | Decedent Father (RelatedPersonParentVitalRecords)
Decedent Spouse | Decedent Spouse (USCoreRelatedPerson)
Decedent Military Service | Decedent Military Service (Observation)
Decedent Usual Work | Used to send text-string industry and occupation information from Jurisdictions to NCHS, and coded versions from NCHS to Jurisdictions.

### Vital Records Linkages

These profiles support exchange of vital records identifiers for events that are related to the decedent. Jurisdictions may provide linkages to birth records for all deaths within the first year of life, and linkages to birth or fetal death records when the for pregnancy-related events within one year of death.

Birth Record Identifier Infant | Birth Record Identifier Infant (Observation). This includes the record identifier, the jurisdiction, and the birth year of the decedent infant whose death is being reported. For maternal death cases, see BirthRecordIdentifierChild and FetalDeathRecordIdentifier.
Birth Record Identifier Child | Birth Record Identifier (Observation). For use in Maternal Death. This includes the record identifier, the jurisdiction, and the birth year of a child. The subject is a Decedent (mother) whose death was related to the birth referenced by the identifier.
Fetal Death Record Identifier | Fetal Death Record Identifier (Observation). For use in Maternal Death. This includes the record identifier, the jurisdiction, and the birth year. The subject is the Decedent (mother), whose death was related to the birth of the fetus referenced by the identifier.

### Death Investigation

Data obtained during the course of investigating a death. Many of these items are conditionally present in a death certification transaction depending on whether or not an autopsy was performed, an injury incident occurred, or a transportation event was involved. The details on the pronouncement performer can be provided using USCore Practitioner profile.

Autopsy Performed Indicator | Autopsy Performed Indicator (Observation)
Death Date | The Death Date profile (Observation) provides the death date, death pronouncer, and date pronounced dead. If the actual date of death is known, set value to type dateTime. If the date of death is not known, and a range is known, set value to type Period. This profile is designed to supplant the similar profiles in VRDR and MDI.
Decedent Pregnancy | The Decedent Pregnancy Status profile (Observation) provides an indication of the pregnancy status of the decedent. This profile is designed to support VRDR and MDI
Death Location | Death Location (LocationVitalRecords)
Examiner Contacted | Examiner Contacted (Observation)
Injury Location | Injury Location (LocationVitalRecords)
Injury Incident | This Observation provides the certified explanation of how the injury leading to death occurred.
Surgery Date | Date of Surgery (Observation). The PartialDate extension supports partial dates.
Tobacco Use Contributed To Death | Tobacco Use Contributed To Death (Observation)

### Death Certification

Data related to the primary concern of the VRDR IG, Death Certification. In this group, the causes of death and the causal pathway are documented and attested to by a death certifier (coroner or medical examiner).

Death Certifier | The Death Certification Practitioner
Cause Of Death Part 1 | The Cause of Death Part 1 (Observation) profile reflects the ordered causes of death asserted by the death certifier. The cause of death is initially specified with text. Line number can be 1-4
Cause of Death Part 2 | The Contributing Cause of Death Part 2 (Observation) profile is used to identify factors contributing to the cause of death as asserted by the death certifier.
Death Certification Procedure | Death Certification Procedure (USCoreProcedure). The procedure where the certification of death was performed by the certifier (USCoreProcedure).
Manner of Death | Manner of Death (Observation)

### Decedent Disposition

Data related to the disposition of the decedents remains. The data in this profile group is typically provided by the funeral home performing the disposition services. The content of this profile group is authenticated by the funeral home director. Additional content can be included using standard USCore profiles, and can be included to specify the Funeral Home Director, the Licensee, and the Mortician.

Disposition Location | Disposition Location (USCoreLocation)
Decedent Disposition Method | Decedent Disposition Method (Observation)
Funeral Home | Funeral Home (USCoreOrganization)
Mortician | Mortician. Note This profile is not needed for submission of records to NCHS but may be relevant for other use cases.

### Coded Observations

Coded Observations based on the submitted death record.

Activity at Time of Death | Activity at Time of Death (Observation)
Automated Underlying Cause Of Death | Automated Underlying Cause Of Death (Observation)
Manual Underlying Cause Of Death | Manual Underlying Cause Of Death (Observation)
Record Axis Cause Of Death | Record Axis Cause Of Death (Observation): Up to 20 of instances of this profile may be included in a coding bundle. Each instance is labeled with its position (1-20), forming an ordered collection of codes. Record axis codes eliminate contradictions and repetitive codes to create a more concise and consistent set of codes than provided by the Entity Axis codes. They may combine or modify codes to better reflect the overall medical certification on the death certificate.
Entity Axis Cause Of Death | Entity Axis Cause Of Death (Observation): Up to 20 of instances of this profile may be included in a coding bundle. Each instance is labeled with its lineNumber, Position and e-code indicator. Entity Axis codes represent the raw data as originally reported on the death certificate by the certifier, maintaining the order and position of conditions as they appeared on the death certificate. They include codes for all causes of death listed, including duplicate codes and potentially contradictory information.
Place Of Injury | Place Of Injury (Observation)
Coding Status Values | Coding Status Values (Parameters) contains various status flags that result from the coding process

### Bundles and Compositions

Bundles and Compositions used to transmit death record content.

Death Certificate | The body of the death certificate document (Composition).
Death Certificate Document | The resources comprising the death certificate composition (Bundle/Document).
Cause of Death Coded Content Bundle | Cause of Death Coded Content Bundle (Bundle): A bundle containing instances of the resources comprising cause of death coded content. This bundle is information-content equivalent to the traditional NCHS TRX format.
Demographic Coded Content Bundle | Demographic Coded Content Bundle (Bundle): A bundle containing instances of the resources comprising demographic (race and ethnicity) coded content.
Industry Occupation Coded Content Bundle | Industry and Occupation Coded Content Bundle (Bundle): A bundle containing coded industry and occupation data for a decedent. This bundle is information-content equivalent to the traditional MIO files.
Mortality Roster Bundle | Mortality Roster Bundle (Bundle): A bundle containing instances of the resources comprising mortality roster content. This bundle is information-content equivalent to the traditional Mortality Roster. The mortality roster is a supplemental report of death for the purpose of notifying the decedent's jurisdiction of birth that the death has occurred. The roster data points are sufficient to locate the birth certificate of the decedent but do not otherwise contain the full death record. Once received, the jurisdiction of birth uses the mortality roster data to locate the record of birth and marks it as deceased.

### Extensions

Extensions

Alias Status of a Death Roster | Alias Status of a Death Roster. If true, is an alias record.
Filing Format | Filing Format Extension.
State Specific Field | An arbitratry string included by a submitting jurisdiction
NVSS SexAtDeath | Sex on visual inspection at the time of death by the funeral home
Spouse Is Alive | Spouse is Alive.
Replacement Status of a Death Record (deprecated) | Replacement Status of a Death Record. The use of this extension has been deprecated and wil be ignored for NCHS submissions. See the [NCHS Vital Records Messaging IG] for a description of how to specify replace status at the message level.
Practitioner Role | Used to indicate the role played by a practitioner to facilitate simple FHIRPath-based queries.

### CodeSystems

CodeSystems

Activity at Time of Death CodeSystem | Activity at Time of Death Codesystem
Date of Death Determination Methods | Date of Death Determination Methods CodeSystem
Death Pregnancy Status Codesystem | Codes that reflect whether the decedent was pregnant at or around the time of death.
Document Section | Document Section Code System
Filing Formats | Death Certificate Filing Formats CodeSystem
Intentional Reject | Intentional Reject CodeSystem
Location Type | Location Type Code System
Local Observation Codes | Local Observation Codes for observations that lack an appropriate LOINC code
Local Component Codes | Local Component Codes for observation components that lack an appropriate LOINC code
Local Organization Type | Local Organization Types
Replacement Status of Death Record Submission CodeSystem | Replacement Status of Death Record Submission CodeSystem
Supermicar Place Of Injury CodeSystem | Supermicar Place Of Injury CodeSystem
System Reject Code System | System Reject Code System
Transax Conversion CodeSystem | Transax Conversion Code System

### ValueSets

ValueSets

Administrative Gender ValueSet | The gender of a person used for administrative purposes. Mapping to IJE codes here.
Certifier Types Value Set | Certifier Types Value Set Mapping to IJE codes here.
Intentional Reject ValueSet | Intentional Reject ValueSet. Mapping to IJE codes here.
System Reject ValueSet | System Reject ValueSet. Mapping to IJE codes here.
Transax Conversion ValueSet | Transax Conversion ValueSet. Mapping to IJE codes here.
Activity at Time of Death ValueSet | Activity at Time of Death. Mapping to IJE codes here.
ICD10 Causes of Death ValueSet | ICD10 Causes of Death ValueSet
Contributory Tobacco Use ValueSet | Did Tobacco Use Contribute to Death Mapping to IJE codes here.
Date of Death Determination Methods Value Set | Date of Death Determination Methods Value Set. The method of date of death determination is not used for the Death Record submission process. The binding to this value set is included for compatibility with the Medicolegal Death Investigation (MDI) Implementation Guide. The valueset only includes the values used by MDI, but is bound extensibly. If a jurisdiction chooses to use this field, and requires additional values (e.g., 'presumed'), these values can be used while remaining in full conformance with the VRDR IG.
Event Code for Death Certificate Composition | The code used for Event.code for the Death Certificate Composition
Event Code for Death Certificate Composition - Max | The maximum valueset for Event.code for Death Certificate Composition. Includes an inactive but valid code used in STU2
Death Pregnancy Status ValueSet | A set of codes that reflect whether the decedent was pregnant at or around the time of death. Based on Pregnancy Status (NCHS)[2.16.840.1.114222.4.11.6003].
Filing Format ValueSet | Filing Format ValueSet Mapping to IJE codes here.
Manner of Death ValueSet | A set of code used to indicate a classification of the manner of death. Mapping to IJE codes here.
Method of Disposition ValueSet | The set of codes used to indicate the method used to dispose of the decedents remains. Mapping to IJE codes here.
Place of Death ValueSet | Code values reflecting the death location of the decedent (e.g., hospital, home, hospice). Mapping to IJE codes here.
Place of Injury ValueSet | Place of Injury from NCHS TRX Format. THis contains all of the codes from https://loinc.org/LL1051-3/ except for LA14087-3 (Public Institution). Mapping to IJE codes here.
Place of Injury - Other ValueSet | Place of Injury from NCHS SuperMicar Format. This provides additional detail when the TRX code is 'Other'.
Replacement Status ValueSet | Replacement Status Value Set. NCHS will not process original or update submissions flagged 'updated_notforNCHS'. Mapping to IJE codes here.
Spouse Alive ValueSet | The set of codes used to indicate whether the decedent's spouse is alive. Mapping to IJE codes here.
Transportation Incident Role ValueSet | Role of the decedent in a transportation incident resulting in a death-related injury. Mapping to IJE codes here.
Edit Bypass 01 | A subset of code values (0 and 1) use to indicate the outcome of data validation assessment for unusual data values.
Edit Bypass 012 | A subset of code values (0, 1, and 2) use to indicate the outcome of data validation assessment for unusual data values.
Edit Bypass 0124 | A subset of code values (0, 1, 2, and 4) use to indicate the outcome of data validation assessment for unusual data values.

### ConceptMaps

ConceptMaps

ActivityAtTimeOfDeath Concept Map | Concept Map for ActivityAtTimeOfDeath Value Set
AdministrativeGender Concept Map | A mapping between NCHS IJE and FHIR AdministrativeGender Value Sets
CertifierTypes Concept Map | A mapping between NCHS IJE and FHIR CertifierTypes Value Sets
ContributoryTobaccoUse Concept Map | A mapping between NCHS IJE and FHIR ContributoryTobaccoUse Value Sets
PregnancyStatus Concept Map | A mapping between NCHS IJE and FHIR PregnancyStatus Value Sets
EditBypass01 Concept Map | A mapping between NCHS IJE and FHIR EditBypass01 Value Sets
EditBypass012 Concept Map | A mapping between NCHS IJE and FHIR EditBypass012 Value Sets
EditBypass0124 Concept Map | A mapping between NCHS IJE and FHIR EditBypass0124 Value Sets
FilingFormat Concept Map | A mapping between NCHS IJE and FHIR FilingFormat Value Sets
IntentionalReject Concept Map | A mapping between NCHS IJE and FHIR IntentionalReject Value Sets
MannerOfDeath Concept Map | A mapping between NCHS IJE and FHIR MannerOfDeath Value Sets
MethodOfDisposition Concept Map | A mapping between NCHS IJE and FHIR MethodOfDisposition Value Sets
PlaceOfDeath Concept Map | A mapping between NCHS IJE and FHIR PlaceOfDeath Value Sets
PlaceOfInjury Concept Map | A mapping between NCHS IJE and FHIR PlaceOfInjury Value Sets
ReplaceStatus Concept Map | A mapping between NCHS IJE and FHIR ReplaceStatus Value Sets
SpouseAlive Concept Map | A mapping between NCHS IJE and FHIR SpouseAlive Value Sets
SystemReject Concept Map | A mapping between NCHS IJE and FHIR SystemReject Value Sets
TransaxConversion Concept Map | A mapping between NCHS IJE and FHIR TransaxConversion Value Sets
TransportationIncidentRole Concept Map | A mapping between NCHS IJE and FHIR TransportationIncidentRole Value Sets

### Example Death Record Submission

Example of a complete Death Record Submission

DeathCertificateDocument-UT-1 | Example Record from UT
Death Certificate for Davis Lineberry Jr | DeathCertificateUT-Example1
DecedentUT-Example1 | DecedentUT-Example1
InputRaceAndEthnicityUT-Example1 | InputRaceAndEthnicityUT-Example1
PractitionerUT-Certifier | Certifying Practitioner
PractitionerUT-Pronouncer | Pronouncing Practitioner
BirthRecordIdentifierUT-Example1 | BirthRecordIdentifierUT-Example1
EducationUT-Example1 | EducationUT-Example1
FatherUT-Example1 | FatherUT-Example1
MotherUT-Example1 | MotherUT-Example1
AutopsyPerformedIndicatorUT-Example1 | AutopsyPerformedIndicatorUT-Example1
CauseOfDeathPart1UT-Example1 | CauseOfDeathPart1UT-Example1
DeathDateUT-Example1 | DeathDateUT-Example1
DeathLocationUT-Example1 | DeathLocationUT-Example1
AgeUT-Example1 | AgeUT-Example1
DispositionMethodUT-Example1 | DispositionMethodUT-Example1
DispositionLocationUT-Example1 | DispositionLocationUT-Example1
UsualWorkUT-Example1 | UsualWorkUT-Example1
MilitaryServiceUT-Example1 | MilitaryServiceUT-Example1
PregnancyUT-Example1 | PregnancyUT-Example1
ExaminerContactedUT-Example1 | ExaminerContactedUT-Example1
FuneralHomeUT-Example1 | FuneralHomeUT-Example1
InjuryIncidentUT-Example1 | InjuryIncidentUT-Example1
MannerOfDeathUT-Example1 | MannerOfDeathUT-Example1
TobaccoUseUT-Example1 | TobaccoUseUT-Example1
ProcedureDeathCertificationUT-Example1 | ProcedureDeathCertificationUT-Example1
EmergingIssuesUT-Example1 | EmergingIssuesUT-Example1

### Other Example Bundles

Example Death Certificate, Coded Content, and Mortality Roster Bundles

CauseOfDeathCodedContentBundle-Example1 | CauseofDeathCodedContentBundle-Example1
DemographicCodedContentBundle-Example1 | DemographicCodedContentBundle-Example1
IndustryOccupationCodedContentBundle-Example1 | IndustryOccupationCodedContentBundle-Example1
MortalityRosterBundle-Example1 | MortalityRosterBundle-Example1
DeathCertificateDocument-Example1 | DeathCertificateDocument-Example1
DeathCertificateDocument-Example2 | DeathCertificateDocument-Example2 (with coded content)

### Other Example Instances

Other Example instances illustrating various aspects of the profiles.

DeathCertification-Example1 | DeathCertification-Example1
DeathCertification-Example2 | DeathCertification-Example1
AutopsyPerformedIndicator-Example1 | AutopsyPerformedIndicator-Example1
BirthRecordIdentifier-Example1 | BirthRecordIdentifier-Example1 - identifier of the decedent's birth certificate
BirthRecordIdentifierChild-Example1 | BirthRecordIdentifierChild-Example1 - identifier of the decedent's child's birth certificate number
FetalDeathRecordIdentifier-Example1 | FetalDeathRecordIdentifier-Example1 - identifier of the decedent's fetus's fetal death record
CauseOfDeathPart1-Example1 | CauseOfDeathPart1New-Example1
CauseOfDeathPart1-Example2 | CauseOfDeathPart1New-Example2
CauseOfDeathPart2-Example1 | CauseOfDeathPart2New-Example1
Certifier-Example1 | Certifier-Example1
AutomatedUnderlyingCauseOfDeath-Example1 | AutomatedUnderlyingCauseOfDeath-Example1
RecordAxisCauseOfDeath-Example1 | RecordAxisCauseOfDeath-Example1
RecordAxisCauseOfDeath-Example2 | RecordAxisCauseOfDeath-Example2
EntityAxisCauseOfDeath-Example1 | EntityAxisCauseOfDeath-Example1
EntityAxisCauseOfDeath-Example2 | EntityAxisCauseOfDeath-Example2
EntityAxisCauseOfDeath-Example3 | EntityAxisCauseOfDeath-Example3
EntityAxisCauseOfDeath-Example4 | EntityAxisCauseOfDeath-Example3
ManualUnderlyingCauseOfDeath-Example1 | ManualUnderlyingCauseOfDeath-Example1
PlaceOfInjury-Example1 | PlaceOfInjury-Example1
ActivityAtTimeOfDeath-Example1 | ActivityAtTimeOfDeath-Example1
CodedRaceAndEthnicity-Example1 | CodedRaceAndEthnicity-Example1
InputRaceAndEthnicity-Example1 | InputRaceAndEthnicity-Example1
CodingStatusValues-Example1 | CodingStatusValues-Example1
DeathCertificate Example1 | DeathCertificate-Example1
DeathCertificate Example2 | DeathCertificate-Example2 (with coded content)
DeathDate-Example1 | DeathDate-Example1
DeathDate-Example2 | DeathDate-Example1
DeathDate-Example3 | DeathDate-Example3 - Stripped down for Mortality Roster
DeathDate-Example4 | DeathDate-Example4 - an example with only a death time
DeathLocation-Example1 | DeathLocation-Example1 - State = Jurisdiction
DeathLocation-Example2 | DeathLocation-Example2 - State != Jurisdiction
DeathLocation-Example3 | DeathLocation-Example3 - Stripped Down for Mortality Roster
Decedent-Example3 | Decedent-Example3 - Stripped down for Mortality Roster
Decedent-Example2 | Decedent-Example2 - with birth jurisdiction
Decedent-Example1 | Decedent-Example1
DecedentAge-Example1 | DecedentAge-Example1
DecedentDispositionMethod-Example1 | DecedentDispositionMethod-Example1
Mortician-Example1 | Mortician-Example1
DispositionLocation-Example1 | DispositionLocation-Example1
DecedentEducationLevel-Example1 | DeathDate-Example1
DecedentMilitaryService-Example1 | DecedentMilitaryService-Example1
DecedentPregnancyStatus-Example1 | DecedentPregnancyStatus-Example1
DecedentUsualWork-Example1 | DecedentUsualWork-Example1 - without coded values
DecedentUsualWork-Example2 | DecedentUsualWork-Example2 - with coded values
EmergingIssues-Example1 | EmergingIssues-Example1 make sure it is example
ExaminerContacted-Example1 | AutopsyPerformedIndicator-Example1
DecedentFather-Example1 | DecedentFather-Example1
DecedentMother-Example1 | DecedentFather-Example1
DecedentSpouse-Example1 | DecedentSpouse-Example1
FuneralHome-Example1 | FuneralHome-Example1
InjuryIncident-Example1 | InjuryIncident-Example1 (with literal transportationRole)
InjuryIncident-Example2 | InjuryIncident-Example2 (with coded transportationRole)
InjuryLocation-Example1 | InjuryLocation-Example1
MannerOfDeath-Example1 | MannerOfDeath-Example1
SurgeryDate-Example1 | SurgeryDate-Example1
TobaccoUseContributedToDeath-Example1 | TobaccoUseContributedToDeath-Example1
Atlanta GA Death Location - Freeman | Example
Atlanta GA Injury Location - Freeman | Example
Practitioner - Vital Records - Janet Seito | Practitioner - Vital Records: Janet Seito example
Procedure - Death Certification Vital Records - A Freeman | Example
USCorePatient - Patient example [A Freeman] | Example of US Core Patient profile (A Freeman)
Pronouncer-Example1 | Pronouncer-Example1
Certifier-Example2-no-NPI | Certifier-Example2 (no NPI)