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

## Change Log

### VRDR STU3 Changes

- Documentation changes to align CauseOfDeathCodedContentBundle with TRX
- Added support for sending the State Specific Field (STATESP) back to jurisdictions as part of the TRX-equivalent CauseOfDeathCodedContentBundle
- Added a new Mortician profile in support of Funeral Home use cases. Use of this profile is not required for submissions to NCHS.
- Support expression of state and jurisdiction for residence of decedent to support routing of records to jurisdiction
- Eliminated the requirement to specify DeathCertification.category since it served no real purpose and used a vague and now inactive SNOMEDCT Code (103693007 "Diagnostic procedure (procedure)"). Allowed continued use of the inactive code for the required DeathCertificate.event.code for compatibility, but added a preferred code (307930005 "Death certificate (record artifact)").
- Documented the use of the Patient.identifier[SSN] slice for Decedent Social Security Number. STU2.2 documented in narrative the use of the [SB] slice, but the examples used the [SSN] slice.
- Changed the valueset for gender used by the NVSSSexAtDeath to use the same codesystem used by USCore and VRCL. Added a maximum binding for backward compability with STU2.2, and provided Concept Maps for mapping the old valuesets ([AdministrativeGenderOldCM]) and new valuesets(AdministrativeGenderCM) to IJE.
- Added profiles supporting maternal death reporting requirements to link birth certificate (BirthRecordIdentifierChild) or fetal death report (FetalDeathRecordIdentifier) associated with maternal death, and added them as optional content in DeathCertificate composition. The subject of all of three linkage identifier observations is the decedent.
- Clarified that certificate numbers are 6 digit numbers with leading zeroes allowed. They are (unfortunately) defined as FHIR strings.
- Restricted ExtensionLocationJurisdictionIdVitalRecords Extension to Address.state context.
- Added a new bundle for Coded Industry and Occupation: IndustryOccupationCodedContentBundle with an example IndustryOccupationCodedContentBundle-Example1 to address
- Modified composition examples to use ruleset for general cleanup and to address publisher errors related to fullurl based rules around matching relative references

#### Harmonization Changes

- For a detailed description of harmonization changes see STU2.2 to STU3 Changes.
- All references to Decedent are not references to PatientVitalRecords that is defined in VRCL. The latter is essentially a USCorePatient profile with optional extensions for vital records uses. This allows reuse of VRDR profiles in MDI STU2. Decedent is now a profile of PatientVitalRecords.
- MaritalStatus valueset and corresponding concept map were moved to VRCL for general utility. Decedent profile made to reference MaritalStatus VS in VRCL.
- DeathLocation, InjuryLocation, and DispositionLocation were updated to depend on the abstract LocationVitalRecords profile in VRCL.
- Edit flag valueset harmonization: Deleted BypassEditFlagCS and referenced VRCL Edit Flags Codesystem instead
- Record identifiers harmonization: Removed AuxiliaryStateIdentifier1, AuxiliaryStateIdentifier2, and CertificateNumber from VRDR and referenced extensions in VRCL
- Removed LocationJurisdictionID as it exists in VRCL and is only used for the abstract PatientVitalRecords and LocationVitalRecords profiles in VRCL.
- [DateDay], [DateMonth], [DateYear], and [DateTime] had been used by [PartialDateTime], which has been moved to VRCL and no longer uses these extensions
- To keep general demographic and non-death-specific information in VRCL, CodedRaceAndEthnicity, InputRaceAndEthnicity, and EmergingIssues moved to VRCL
- NA code added to DeathPregnancyStatusVS
- Made Certifier derive from PractitionerVitalRecords and added extension PractitionerRole that can be used to distinguish certifier and mortician from other practitioner types in the bundle
- Removed local codes meant from VRCL from ObservationsCS

### Changes in Previous Versions

For changes in previous versions, please see the appropriate version.