UV_Vital Records Birth and Fetal Death Reporting
1.1.0 - STU 1.1
UV_Vital Records Birth and Fetal Death Reporting
1.1.0 - STU 1.1
UV_Vital Records Birth and Fetal Death Reporting, published by IHE International. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/fhir-bfdr/ and changes regularly. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="bundle-provider-fetal-death-not-named"/>
<meta>
<versionId value="4"/>
<lastUpdated value="2023-08-29T06:22:00.568Z"/>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Bundle-document-bfdr"/>
</meta>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:93bdc9cf-0d97-4b6f-9f11-876d8ea115eb"/>
</identifier>
<type value="document"/>
<timestamp value="2019-02-11T02:06:01.283Z"/>
<entry>
<fullUrl
value="http://example.org/fhir/Composition/composition-provider-fetal-death-not-named"/>
<resource>
<Composition>
<id value="composition-provider-fetal-death-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Composition-provider-fetal-death-report"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Composition_composition-provider-fetal-death-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Composition composition-provider-fetal-death-not-named</b></p><a name="composition-provider-fetal-death-not-named"> </a><a name="hccomposition-provider-fetal-death-not-named"> </a><a name="hccomposition-provider-fetal-death-not-named-en-US"> </a><p><b>identifier</b>: z03eab8c-11e8-4d0c-ad2a-b385395e27da</p><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{http://loinc.org 69045-3}">U.S. standard report of fetal death - 2003 revision</span></p><p><b>encounter</b>: <a href="Encounter-encounter-maternity-carmen-teresa-lee.html">Encounter - Maternity (Carmen Teresa Lee)</a></p><p><b>date</b>: 2019-01-09</p><p><b>author</b>: <a href="Practitioner-practitioner-vital-records-jessica-leung.html">Practitioner - Vital Records (Jessica Leung)</a></p><p><b>title</b>: Provider fetal death report Document</p></div>
</text>
<extension
url="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Extension-fetal-death-report-number">
<valueIdentifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="FDR"/>
</coding>
</type>
<value value="9876"/>
</valueIdentifier>
</extension>
<extension
url="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Extension-fetal-death-local-file-number">
<valueIdentifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="FDRFN"/>
</coding>
</type>
<value value="11111-11111"/>
</valueIdentifier>
</extension>
<extension
url="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Extension-date-received-by-registrar">
<valueDateTime value="2019-02-12"/>
</extension>
<identifier>
<value value="z03eab8c-11e8-4d0c-ad2a-b385395e27da"/>
</identifier>
<status value="final"/>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="69045-3"/>
<display
value="U.S. standard report of fetal death - 2003 revision"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<encounter>🔗
<reference value="Encounter/encounter-maternity-carmen-teresa-lee"/>
<display value="Encounter - Maternity (Carmen Teresa Lee)"/>
</encounter>
<date value="2019-01-09"/>
<author>🔗
<reference
value="Practitioner/practitioner-vital-records-jessica-leung"/>
<display value="Practitioner - Vital Records (Jessica Leung)"/>
</author>
<title value="Provider fetal death report Document"/>
<section>
<title value="Mother (prenatal) Section on the Fetal Death Report"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="57073-9"/>
<display value="Prenatal records"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-planned-to-deliver-at-home-not-named"/>
<display
value="Observation - Planned to Deliver at Home (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
<display
value="Observation - Date of First Prenatal Care Visit (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-last-menstrual-period-carmen-teresa-lee"/>
<display
value="Observation - Last Menstrual Period (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-number-births-now-living-carmen-teresa-lee"/>
<display
value="Observation - Number Births Now Living (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-number-births-now-dead-carmen-teresa-lee"/>
<display
value="Observation - Number Births Now Dead (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-date-of-last-live-birth-carmen-teresa-lee"/>
<display
value="Observation - Date of Last Live Birth (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-height-carmen-teresa-lee"/>
<display value="Observation - Mother Height (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
<display
value="Observation - Mother Prepregnancy Weight (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-received-wic-food-carmen-teresa-lee"/>
<display
value="Observation - Mother Received WIC Food (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
<display
value="Observation - Cigarette Smoking Before/During Pregnancy (3 months prior: Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
<display
value="Observation - Cigarette Smoking Before/During Pregnancy (first 3 months: Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
<display
value="Observation - Cigarette Smoking Before/During Pregnancy (last 3 months: Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
<display
value="Observation - Cigarette Smoking Before/During Pregnancy (second 3 months: Carmen Teresa Lee)"/>
</entry>
</section>
<section>
<title
value="Medical and Health Information on the Fetal Death Report"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="55752-0"/>
<display value="Clinical information"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-number-previous-cesareans-carmen-teresa-lee"/>
<display
value="Observation - Number Previous Cesareans (Carmen Teresa Lee)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-fetal-presentation-not-named"/>
<display
value="Observation - Fetal Presentation (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Procedure/procedure-final-route-method-delivery-not-named"/>
<display
value="Procedure - Final Route and Method of Delivery (Fetus Not Named)"/>
</entry>
</section>
<section>
<title
value="Fetal delivery information section on the Fetal Death Report"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="76400-1"/>
<display
value="Fetal delivery information Document [US Standard Report of Fetal Death]"/>
</coding>
</code>
<entry>🔗
<reference
value="Observation/observation-birth-weight-not-named"/>
<display value="Observation - Birth Weight (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-gestational-age-at-delivery-not-named"/>
<display
value="Observation - Gestational Age at Delivery (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Condition/condition-fetal-death-cause-or-condition-not-named"/>
<display
value="Condition - Fetal Death Cause or Condition (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Condition/condition-fetal-death-other-significant-cause-not-named"/>
<display
value="Example of Condition-fetal-death-other-significant-cause profile (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-fetal-death-time-point-not-named"/>
<display
value="Example of Observation-estimated-fetal-death-time-point profile (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-autopsy-performed-not-named"/>
<display
value="Example of Observation-autopsy-performed profile (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-histological-placental-exam-performed-not-named"/>
<display
value="Observation - Histological Placental Exam Performed (Fetus Not Named)"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-autopsy-histological-exam-results-used-not-named"/>
<display
value="Observation - Autopsy or Histological Exam Results Used"/>
</entry>
</section>
<section>
<title
value="Mother Administrative Section on the Fetal Death Report"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="92014-0"/>
<display value="Mother's administrative information"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-parent-education-level-carmen-teresa-lee"/>
<display
value="Observation - Parent Education Level (Carmen Teresa Lee)"/>
</entry>
</section>
<section>
<title value="Mother's QuestionnaireResponse Section"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="74465-6"/>
<display value="Questionnaire response Document"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<entry>🔗
<reference
value="QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
<display
value="QuestionnaireResponse - Patient's Worksheet for Fetal Death Report"/>
</entry>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Patient/patient-decedent-fetus-not-named"/>
<resource>
<Patient>
<id value="patient-decedent-fetus-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Patient-decedent-fetus-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_patient-decedent-fetus-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Patient patient-decedent-fetus-not-named</b></p><a name="patient-decedent-fetus-not-named"> </a><a name="hcpatient-decedent-fetus-not-named"> </a><a name="hcpatient-decedent-fetus-not-named-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">UNK Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Known status of Patient">Deceased:</td><td colspan="3">true</td></tr><tr><td style="background-color: #f3f5da" title="The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements."><a href="http://hl7.org/fhir/extensions/5.1.0/StructureDefinition-patient-birthPlace.html">Patient Birth Place</a></td><td colspan="3">Ann Arbor MI 48103 </td></tr><tr><td style="background-color: #f3f5da" title="A code classifying the person's sex assigned at birth as specified by the [Office of the National Coordinator for Health IT (ONC)](https://www.healthit.gov/newsroom/about-onc). This extension aligns with the C-CDA Birth Sex Observation (LOINC 76689-9)."><a href="http://hl7.org/fhir/us/core/STU5.0.1/StructureDefinition-us-core-birthsex.html">US Core Birth Sex Extension</a></td><td colspan="3">F</td></tr><tr><td style="background-color: #f3f5da" title="The fetal death status of the patient."><a href="http://hl7.org/fhir/us/vr-common-library/STU1.1/StructureDefinition-Extension-patient-fetal-death-vr.html">Extension - Patient Fetal Death - Vital Records</a></td><td colspan="3"><a href="http://snomed.info/id/276507005">SNOMED CT (all versions)</a> 276507005: Fetal death (event)</td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthPlace">
<valueAddress>
<city value="Ann Arbor"/>
<state value="MI"/>
<postalCode value="48103"/>
</valueAddress>
</extension>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-patient-fetal-death-vr">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="276507005"/>
<display value="Fetal death (event)"/>
</valueCoding>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
</type>
<system value="http://hospital.smarthealthit.org"/>
<value value="9932702"/>
</identifier>
<name>
<family value="UNK">
<extension
url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
<valueCode value="not-applicable"/>
</extension>
</family>
</name>
<gender value="female"/>
<birthDate value="2019-01-09">
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthTime">
<valueDateTime value="2019-01-09T18:23:00-07:00"/>
</extension>
</birthDate>
<deceasedBoolean value="true"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Encounter/encounter-maternity-carmen-teresa-lee"/>
<resource>
<Encounter>
<id value="encounter-maternity-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Encounter-maternity"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_encounter-maternity-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee</b></p><a name="encounter-maternity-carmen-teresa-lee"> </a><a name="hcencounter-maternity-carmen-teresa-lee"> </a><a name="hcencounter-maternity-carmen-teresa-lee-en-US"> </a><p><b>identifier</b>: <code>http://hospital.smarthealthit.org</code>/8937015</p><p><b>status</b>: Finished</p><p><b>class</b>: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-IMP">ActCode</a> IMP: inpatient encounter</p><p><b>type</b>: <span title="Codes:{http://www.ama-assn.org/go/cpt 99234}">Under Observation or Inpatient Care Services (Including Admission and Discharge Services)</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><h3>Participants</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Individual</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://loinc.org 87286-1}">Birth attendant [Extended Identifier]</span></td><td><a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner - Vital Records (Janet Seito, MD)</a></td></tr></table><p><b>period</b>: 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700</p><h3>Locations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Location</b></td><td><b>PhysicalType</b></td></tr><tr><td style="display: none">*</td><td><a href="Location-location-south-hospital.html">Location - US Core Location (South Hospital)</a></td><td><span title="Codes:{http://snomed.info/sct 22232009}">Hospital</span></td></tr></table><p><b>serviceProvider</b>: <a href="Organization-organization-south-hospital.html">Organization - US Core Organization (South Hospital Organization)</a></p></div>
</text>
<identifier>
<system value="http://hospital.smarthealthit.org"/>
<value value="8937015"/>
</identifier>
<status value="finished"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="IMP"/>
<display value="inpatient encounter"/>
</class>
<type>
<coding>
<system value="http://www.ama-assn.org/go/cpt"/>
<code value="99234"/>
</coding>
<text
value="Under Observation or Inpatient Care Services (Including Admission and Discharge Services)"/>
</type>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<participant>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="87286-1"/>
<display value="Birth attendant [Extended Identifier]"/>
</coding>
</type>
<individual>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
<display value="Practitioner - Vital Records (Janet Seito, MD)"/>
</individual>
</participant>
<period>
<start value="2019-01-08T10:00:00-07:00"/>
<end value="2019-01-09T17:00:00-07:00"/>
</period>
<location>
<location>🔗
<reference value="Location/location-south-hospital"/>
<display value="Location - US Core Location (South Hospital)"/>
</location>
<physicalType>
<coding>
<system value="http://snomed.info/sct"/>
<code value="22232009"/>
<display value="Hospital"/>
</coding>
</physicalType>
</location>
<serviceProvider>🔗
<reference value="Organization/organization-south-hospital"/>
<display
value="Organization - US Core Organization (South Hospital Organization)"/>
</serviceProvider>
</Encounter>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Practitioner/practitioner-vital-records-jessica-leung"/>
<resource>
<Practitioner>
<id value="practitioner-vital-records-jessica-leung"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Practitioner-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_practitioner-vital-records-jessica-leung"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner practitioner-vital-records-jessica-leung</b></p><a name="practitioner-vital-records-jessica-leung"> </a><a name="hcpractitioner-vital-records-jessica-leung"> </a><a name="hcpractitioner-vital-records-jessica-leung-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/223347055</p><p><b>name</b>: Leung Jessica </p><h3>Qualifications</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-NullFlavor OTH}">Birth Clerk</span></td></tr></table></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="223347055"/>
</identifier>
<name>
<family value="Jessica"/>
<given value="Leung"/>
</name>
<qualification>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
<code value="OTH"/>
<display value="other"/>
</coding>
<text value="Birth Clerk"/>
</code>
</qualification>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Patient/patient-mother-carmen-teresa-lee"/>
<resource>
<Patient>
<id value="patient-mother-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Patient-mother-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_patient-mother-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Patient patient-mother-carmen-teresa-lee</b></p><a name="patient-mother-carmen-teresa-lee"> </a><a name="hcpatient-mother-carmen-teresa-lee"> </a><a name="hcpatient-mother-carmen-teresa-lee-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Alternate names (see the one above)">Alt. Name:</td><td colspan="3">Carmen Teresa Santos (Name changed for Marriage)</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">3670 Miller Road Ann Arbor MI 48103 US (home)</td></tr><tr><td style="background-color: #f3f5da" title="Patient Links">Links:</td><td colspan="3"><ul><li>Also see: <a href="RelatedPerson-relatedperson-mother-carmen-teresa-lee.html">RelatedPerson Carmen Teresa Lee (official)</a></li></ul></td></tr><tr><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:</td><td colspan="3"><ul><li>ombCategory: <a href="http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2135-2">Race & Ethnicity - CDC</a> 2135-2: Hispanic or Latino</li><li>text: Hispanic or Latino</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements."><a href="http://hl7.org/fhir/extensions/5.1.0/StructureDefinition-patient-birthPlace.html">Patient Birth Place</a></td><td colspan="3">PR </td></tr><tr><td style="background-color: #f3f5da" title="A code classifying the person's sex assigned at birth as specified by the [Office of the National Coordinator for Health IT (ONC)](https://www.healthit.gov/newsroom/about-onc). This extension aligns with the C-CDA Birth Sex Observation (LOINC 76689-9)."><a href="http://hl7.org/fhir/us/core/STU5.0.1/StructureDefinition-us-core-birthsex.html">US Core Birth Sex Extension</a></td><td colspan="3">F</td></tr><tr><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:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White.">US Core Race Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2054-5">Race & Ethnicity - CDC</a> 2054-5: Black or African American</li><li>text: Black or African America</li></ul></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2054-5"/>
<display value="Black or African American"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Black or African America"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2135-2"/>
<display value="Hispanic or Latino"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Hispanic or Latino"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthPlace">
<valueAddress>
<state value="PR"/>
</valueAddress>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
</type>
<system value="http://hospital.smarthealthit.org"/>
<value value="9992702"/>
</identifier>
<name>
<use value="official"/>
<family value="Lee"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<name>
<use value="maiden"/>
<family value="Santos"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<gender value="female"/>
<birthDate value="1986-02-15"/>
<address>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-within-city-limits-indicator-vr">
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</extension>
<use value="home"/>
<line value="3670 Miller Road"/>
<city value="Ann Arbor"/>
<state value="MI"/>
<postalCode value="48103"/>
<country value="US"/>
</address>
<link>
<other>🔗
<reference
value="RelatedPerson/relatedperson-mother-carmen-teresa-lee"/>
</other>
<type value="seealso"/>
</link>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-planned-to-deliver-at-home-not-named"/>
<resource>
<Observation>
<id value="observation-planned-to-deliver-at-home-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-planned-to-deliver-at-home"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-planned-to-deliver-at-home-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-planned-to-deliver-at-home-not-named</b></p><a name="observation-planned-to-deliver-at-home-not-named"> </a><a name="hcobservation-planned-to-deliver-at-home-not-named"> </a><a name="hcobservation-planned-to-deliver-at-home-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73765-0}">Planned to deliver at home?</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: false</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73765-0"/>
<display
value="Mother Planned to deliver at home [US Standard Certificate of Live Birth]"/>
</coding>
<text value="Planned to deliver at home?"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueBoolean value="false"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
<resource>
<Observation>
<id
value="observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-date-of-first-prenatal-care-visit"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee</b></p><a name="observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><a name="hcobservation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><a name="hcobservation-date-of-first-prenatal-care-visit-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 69044-6}">Date of first prenatal care visit</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 2018-05-18</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="69044-6"/>
<display value="Date first prenatal visit"/>
</coding>
<text value="Date of first prenatal care visit"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2018-05-18"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-last-menstrual-period-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-last-menstrual-period-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-last-menstrual-period-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-last-menstrual-period-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee</b></p><a name="observation-last-menstrual-period-carmen-teresa-lee"> </a><a name="hcobservation-last-menstrual-period-carmen-teresa-lee"> </a><a name="hcobservation-last-menstrual-period-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 8665-2}">Last menstrual period start date</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 2018-04-18</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="8665-2"/>
<display value="Last menstrual period start date"/>
</coding>
<text value="Last menstrual period start date"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2018-04-18"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-number-births-now-living-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-births-now-living-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-number-births-now-living-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-births-now-living-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee</b></p><a name="observation-number-births-now-living-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-living-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-living-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11638-4}">[#] Births.still living</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11638-4"/>
<display value="[#] Births.still living"/>
</coding>
<text value="[#] Births.still living"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-number-births-now-dead-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-births-now-dead-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-number-births-now-dead-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-births-now-dead-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee</b></p><a name="observation-number-births-now-dead-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-dead-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-dead-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68496-9}">Previous live births now dead #</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68496-9"/>
<display value="Previous live births now dead #"/>
</coding>
<text value="Previous live births now dead #"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-date-of-last-live-birth-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-date-of-last-live-birth-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-date-of-last-live-birth"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-date-of-last-live-birth-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee</b></p><a name="observation-date-of-last-live-birth-carmen-teresa-lee"> </a><a name="hcobservation-date-of-last-live-birth-carmen-teresa-lee"> </a><a name="hcobservation-date-of-last-live-birth-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68499-3}">Date of last live birth</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 2016-01-28</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68499-3"/>
<display value="Date last live birth"/>
</coding>
<text value="Date of last live birth"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2016-01-28"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-mother-height-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-height-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-mother-height-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-height-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-height-carmen-teresa-lee</b></p><a name="observation-mother-height-carmen-teresa-lee"> </a><a name="hcobservation-mother-height-carmen-teresa-lee"> </a><a name="hcobservation-mother-height-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 3137-7}">Body height Measured</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-01-10</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 65 [in_i]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[in_i] = '[in_i]')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
<display value="Vital Signs"/>
</coding>
<text value="Vital Signs"/>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="3137-7"/>
<display value="Body height Measured"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-01-10"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="65"/>
<system value="http://unitsofmeasure.org"/>
<code value="[in_i]"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-mother-prepregnancy-weight-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee</b></p><a name="observation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><a name="hcobservation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><a name="hcobservation-mother-prepregnancy-weight-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 56077-1}">Body weight --pre current pregnancy</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-05-20</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 180 [lb_av]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[lb_av] = '[lb_av]')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
<display value="Vital Signs"/>
</coding>
<text value="Vital Signs"/>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="56077-1"/>
<display value="Body weight --pre current pregnancy"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-05-20"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="180"/>
<system value="http://unitsofmeasure.org"/>
<code value="[lb_av]"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-mother-received-wic-food-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-received-wic-food-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-mother-received-wic-food"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-received-wic-food-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee</b></p><a name="observation-mother-received-wic-food-carmen-teresa-lee"> </a><a name="hcobservation-mother-received-wic-food-carmen-teresa-lee"> </a><a name="hcobservation-mother-received-wic-food-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87303-4}">Did mother get WIC food for herself during this pregnancy?</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0532 N}">No</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87303-4"/>
<display value="Mother WIC food recipient"/>
</coding>
<text
value="Did mother get WIC food for herself during this pregnancy?"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
<code value="N"/>
<display value="No"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-1-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 64794-1}">In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="64794-1"/>
<display
value="In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]"/>
</coding>
<text
value="In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-2-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87298-6}">Cigarettes smoked per day by Mother--1st trimester</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87298-6"/>
<display
value="Cigarettes smoked per day by Mother--1st trimester"/>
</coding>
<text value="Cigarettes smoked per day by Mother--1st trimester"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-3-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87299-4}">Cigarettes smoked per day by Mother--2nd trimester</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87299-4"/>
<display
value="Cigarettes smoked per day by Mother--2nd trimester"/>
</coding>
<text value="Cigarettes smoked per day by Mother--2nd trimester"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-4-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 64795-8}">In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="64795-8"/>
<display
value="In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]"/>
</coding>
<text
value="In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-number-previous-cesareans-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-previous-cesareans-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-number-previous-cesareans-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-previous-cesareans-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee</b></p><a name="observation-number-previous-cesareans-carmen-teresa-lee"> </a><a name="hcobservation-number-previous-cesareans-carmen-teresa-lee"> </a><a name="hcobservation-number-previous-cesareans-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68497-7}">Previous cesarean deliveries #</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68497-7"/>
<display value="Previous cesarean deliveries #"/>
</coding>
<text value="Previous cesarean deliveries #"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-fetal-presentation-not-named"/>
<resource>
<Observation>
<id value="observation-fetal-presentation-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-fetal-presentation"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-fetal-presentation-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-fetal-presentation-not-named</b></p><a name="observation-fetal-presentation-not-named"> </a><a name="hcobservation-fetal-presentation-not-named"> </a><a name="hcobservation-fetal-presentation-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73761-9}">Fetal presentation--at birth [US Standard Certificate of Live Birth]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 6096002}">Breech presentation (finding)</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73761-9"/>
<display
value="Fetal presentation--at birth [US Standard Certificate of Live Birth]"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="6096002"/>
<display value="Breech presentation (finding)"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Procedure/procedure-final-route-method-delivery-not-named"/>
<resource>
<Procedure>
<id value="procedure-final-route-method-delivery-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Procedure-final-route-method-delivery"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Procedure_procedure-final-route-method-delivery-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Procedure procedure-final-route-method-delivery-not-named</b></p><a name="procedure-final-route-method-delivery-not-named"> </a><a name="hcprocedure-final-route-method-delivery-not-named"> </a><a name="hcprocedure-final-route-method-delivery-not-named-en-US"> </a><p><b>status</b>: Completed</p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 48782003}">Spontaneous vaginal delivery</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>performed</b>: 2019-01-19 18:00:00-0700 --> 2019-01-19 18:23:00-0700</p></div>
</text>
<status value="completed"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="48782003"/>
<display value="Delivery normal (finding)"/>
</coding>
<text value="Spontaneous vaginal delivery"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<performedPeriod>
<start value="2019-01-19T18:00:00-07:00"/>
<end value="2019-01-19T18:23:00-07:00"/>
</performedPeriod>
</Procedure>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-birth-weight-not-named"/>
<resource>
<Observation>
<id value="observation-birth-weight-not-named"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-birth-weight-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-birth-weight-not-named</b></p><a name="observation-birth-weight-not-named"> </a><a name="hcobservation-birth-weight-not-named"> </a><a name="hcobservation-birth-weight-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8339-4}">Birth weight Measured</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-02-10</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 1530 g<span style="background: LightGoldenRodYellow"> (Details: UCUM codeg = 'g')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
<display value="Vital Signs"/>
</coding>
<text value="Vital Signs"/>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="8339-4"/>
<display value="Birth weight Measured"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-02-10"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="1530"/>
<system value="http://unitsofmeasure.org"/>
<code value="g"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-gestational-age-at-delivery-not-named"/>
<resource>
<Observation>
<id value="observation-gestational-age-at-delivery-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-gestational-age-at-delivery-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-gestational-age-at-delivery-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-gestational-age-at-delivery-not-named</b></p><a name="observation-gestational-age-at-delivery-not-named"> </a><a name="hcobservation-gestational-age-at-delivery-not-named"> </a><a name="hcobservation-gestational-age-at-delivery-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11884-4}">Gestational age Estimated</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: 20 wk<span style="background: LightGoldenRodYellow"> (Details: UCUM codewk = 'wk')</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11884-4"/>
<display value="Gestational age Estimated"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="20"/>
<system value="http://unitsofmeasure.org"/>
<code value="wk"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Condition/condition-fetal-death-cause-or-condition-not-named"/>
<resource>
<Condition>
<id value="condition-fetal-death-cause-or-condition-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Condition-fetal-death-cause-or-condition"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_condition-fetal-death-cause-or-condition-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named</b></p><a name="condition-fetal-death-cause-or-condition-not-named"> </a><a name="hccondition-fetal-death-cause-or-condition-not-named"> </a><a name="hccondition-fetal-death-cause-or-condition-not-named-en-US"> </a><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-category encounter-diagnosis}">Encounter Diagnosis</span>, <span title="Codes:{http://loinc.org 76060-3}">Initiating cause or condition of fetal death [US Standard Report of Fetal Death]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 44223004}">Premature rupture of membranes (disorder)</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p></div>
</text>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-category"/>
<code value="encounter-diagnosis"/>
<display value="Encounter Diagnosis"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="76060-3"/>
<display
value="Initiating cause or condition of fetal death [US Standard Report of Fetal Death]"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="44223004"/>
<display value="Premature rupture of membranes (disorder)"/>
</coding>
<text value="Premature rupture of membranes (disorder)"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
</Condition>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Condition/condition-fetal-death-other-significant-cause-not-named"/>
<resource>
<Condition>
<id value="condition-fetal-death-other-significant-cause-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Condition-fetal-death-other-cause-or-condition"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_condition-fetal-death-other-significant-cause-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named</b></p><a name="condition-fetal-death-other-significant-cause-not-named"> </a><a name="hccondition-fetal-death-other-significant-cause-not-named"> </a><a name="hccondition-fetal-death-other-significant-cause-not-named-en-US"> </a><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-category encounter-diagnosis}">Encounter Diagnosis</span>, <span title="Codes:{http://loinc.org 76061-1}">Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 237292005}">Placental insufficiency (disorder)</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p></div>
</text>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-category"/>
<code value="encounter-diagnosis"/>
<display value="Encounter Diagnosis"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="76061-1"/>
<display
value="Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="237292005"/>
<display value="Placental insufficiency (disorder)"/>
</coding>
<text value="Placental insufficiency (disorder)"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
</Condition>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-fetal-death-time-point-not-named"/>
<resource>
<Observation>
<id value="observation-fetal-death-time-point-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-estimated-fetal-death-time-point"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-fetal-death-time-point-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-fetal-death-time-point-not-named</b></p><a name="observation-fetal-death-time-point-not-named"> </a><a name="hcobservation-fetal-death-time-point-not-named"> </a><a name="hcobservation-fetal-death-time-point-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73811-2}">Estimated timing of fetal death [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 434631000124100}">Fetal intrapartum death after first assessment (event)</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73811-2"/>
<display
value="Estimated timing of fetal death [US Standard Report of Fetal Death]"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="434631000124100"/>
<display
value="Fetal intrapartum death after first assessment (event)"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-autopsy-performed-not-named"/>
<resource>
<Observation>
<id value="observation-autopsy-performed-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-autopsy-performed-indicator-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-autopsy-performed-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-autopsy-performed-not-named</b></p><a name="observation-autopsy-performed-not-named"> </a><a name="hcobservation-autopsy-performed-not-named"> </a><a name="hcobservation-autopsy-performed-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 85699-7}">Autopsy was performed</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 716347009}">Autopsy performed (situation)</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="85699-7"/>
<display value="Autopsy was performed"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="716347009"/>
<display value="Autopsy performed (situation)"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-histological-placental-exam-performed-not-named"/>
<resource>
<Observation>
<id
value="observation-histological-placental-exam-performed-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-histological-placental-exam-performed"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-histological-placental-exam-performed-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-histological-placental-exam-performed-not-named</b></p><a name="observation-histological-placental-exam-performed-not-named"> </a><a name="hcobservation-histological-placental-exam-performed-not-named"> </a><a name="hcobservation-histological-placental-exam-performed-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73767-6}">Histological placental examination was performed [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 398166005}">Performed</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73767-6"/>
<display
value="Histological placental examination was performed [US Standard Report of Fetal Death]"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="398166005"/>
<display value="Performed"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-autopsy-histological-exam-results-used-not-named"/>
<resource>
<Observation>
<id
value="observation-autopsy-histological-exam-results-used-not-named"/>
<meta>
<profile
value="https://profiles.ihe.net/QRPH/bfdr/StructureDefinition/Observation-autopsy-histological-exam-results-used"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-autopsy-histological-exam-results-used-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named</b></p><a name="observation-autopsy-histological-exam-results-used-not-named"> </a><a name="hcobservation-autopsy-histological-exam-results-used-not-named"> </a><a name="hcobservation-autopsy-histological-exam-results-used-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 74498-7}">Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Avery Jones </a></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 Y}">Yes</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="74498-7"/>
<display
value="Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="Y"/>
<display value="Yes"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Observation/observation-parent-education-level-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-parent-education-level-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-parent-education-level-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-parent-education-level-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee</b></p><a name="observation-parent-education-level-carmen-teresa-lee"> </a><a name="hcobservation-parent-education-level-carmen-teresa-lee"> </a><a name="hcobservation-parent-education-level-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 57712-2}">Highest level of education Mother</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: <span title="Codes:{urn:oid:2.16.840.1.114222.4.5.274 PHC1449}">9th through 12th grade; no diploma</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="57712-2"/>
<display value="Highest level of education Mother"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="urn:oid:2.16.840.1.114222.4.5.274"/>
<code value="PHC1449"/>
<display value="9th through 12th grade; no diploma"/>
</coding>
<text value="9th through 12th grade; no diploma"/>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
<resource>
<QuestionnaireResponse>
<id value="QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="QuestionnaireResponse_QuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee</b></p><a name="QuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><a name="hcQuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><a name="hcQuestionnaireResponse-patients-fetal-death-carmen-lee-en-US"> </a><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> QuestionnaireResponse-patients-fetal-death-carmen-lee</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire:<a href="Questionnaire-Questionnaire-patients-fetal-death.html">Questionnaire - Patient's Worksheet for the Report of Fetal Death</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-current-legal-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your current legal name?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-first-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Carmen</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-middle-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Middle</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Teresa</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-last-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Last</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Lee</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-address</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Where do you usually live - that is - where is your household/residence located?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-nbr-street</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Complete number and street (do not enter rural route numbers)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">3670 Miller Road</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-city</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">City, Town, or Location</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-state</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">State (or U.S. Territory, Canadian Province)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">MI</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-zip</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Zip Code</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">48103</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> inside-city-limits</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://terminology.hl7.org/5.0.0/CodeSystem-v2-0532.html#v2-0532-N">expandedYes-NoIndicator</a> N: No</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-mail</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your mailing address</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-mail-same</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Same as residence [Go to next question]</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-dob</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your date of birth?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1986-02-15</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mother-birthplace</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">In what State, U.S. territory, or foreign country were you born? Please specify one of the following:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-birthplace-territory</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">PR</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-education</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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).</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>unknown PHC1449: 9th through 12th grade; no diploma</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-ethnicity</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the “No” box. If Spanish/Hispanic/Latina, check the appropriate box.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-shl</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you Spanish/Hispanic/Latina</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2135-2">Race & Ethnicity - CDC</a> 2135-2: Hispanic or Latino</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-race</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your race? (Please check one or more races to indicate what you consider yourself to be).</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-race-category</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Race categories</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2054-5">Race & Ethnicity - CDC</a> 2054-5: Black or African American</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> father-current-legal-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is the current legal name of your baby's father?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> father-first-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Tom</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> father-middle-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Middle</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Yan</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> father-last-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Last</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Lee</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> father-dob</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is the father's date of birth?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1984-02-27</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> father-birthplace</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> father-birthplace-state</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">State</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">NY</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> receive-wic</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://terminology.hl7.org/5.0.0/CodeSystem-v2-0532.html#v2-0532-N">expandedYes-NoIndicator</a> N: No</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-height</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your height?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-height-inches</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Inches</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>65 [in_i]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[in_i] = '[in_i]')</span></span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-prepregnancy-weight</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">lbs</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>180 [lb_av]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[lb_av] = '[lb_av]')</span></span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-3-months-prior</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Three months before pregnancy</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-3-months-prior-cig</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-3-months-prior-pck</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First three months of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-1-cig</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-1-pck</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Second three months of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-2-cig</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-2-pck</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Third trimester of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-3-cig</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-3-pck</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<questionnaire
value="https://profiles.ihe.net/QRPH/bfdr/Questionnaire/Questionnaire-patients-fetal-death"/>
<status value="completed"/>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<source>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</source>
<item>
<linkId value="mother-current-legal-name"/>
<text value="What is your current legal name?"/>
<item>
<linkId value="mother-first-name"/>
<text value="First"/>
<answer>
<valueString value="Carmen"/>
</answer>
</item>
<item>
<linkId value="mother-middle-name"/>
<text value="Middle"/>
<answer>
<valueString value="Teresa"/>
</answer>
</item>
<item>
<linkId value="mother-last-name"/>
<text value="Last"/>
<answer>
<valueString value="Lee"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-address"/>
<text
value="Where do you usually live - that is - where is your household/residence located?"/>
<item>
<linkId value="mother-nbr-street"/>
<text
value="Complete number and street (do not enter rural route numbers)"/>
<answer>
<valueString value="3670 Miller Road"/>
</answer>
</item>
<item>
<linkId value="mother-city"/>
<text value="City, Town, or Location"/>
</item>
<item>
<linkId value="mother-state"/>
<text value="State (or U.S. Territory, Canadian Province)"/>
<answer>
<valueString value="MI"/>
</answer>
</item>
<item>
<linkId value="mother-zip"/>
<text value="Zip Code"/>
<answer>
<valueString value="48103"/>
</answer>
</item>
</item>
<item>
<linkId value="inside-city-limits"/>
<text
value="Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mother-mail"/>
<text value="What is your mailing address"/>
<item>
<linkId value="mother-mail-same"/>
<text value="Same as residence [Go to next question]"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-dob"/>
<text value="What is your date of birth?"/>
<answer>
<valueDate value="1986-02-15"/>
</answer>
</item>
<item>
<linkId value="mother-birthplace"/>
<text
value="In what State, U.S. territory, or foreign country were you born? Please specify one of the following:"/>
<item>
<linkId value="mother-birthplace-territory"/>
<text
value="or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas"/>
<answer>
<valueString value="PR"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-education"/>
<text
value="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)."/>
<answer>
<valueCoding>
<system value="urn:oid:2.16.840.1.114222.4.5.274"/>
<code value="PHC1449"/>
<display value="9th through 12th grade; no diploma"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mother-ethnicity"/>
<text
value="Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the “No” box. If Spanish/Hispanic/Latina, check the appropriate box."/>
<item>
<linkId value="mother-shl"/>
<text value="Are you Spanish/Hispanic/Latina"/>
<answer>
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2135-2"/>
<display value="Hispanic or Latino"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="mother-race"/>
<text
value="What is your race? (Please check one or more races to indicate what you consider yourself to be)."/>
<item>
<linkId value="mother-race-category"/>
<text value="Race categories"/>
<answer>
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2054-5"/>
<display value="Black or African American"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="father-current-legal-name"/>
<text
value="What is the current legal name of your baby's father?"/>
<item>
<linkId value="father-first-name"/>
<text value="First"/>
<answer>
<valueString value="Tom"/>
</answer>
</item>
<item>
<linkId value="father-middle-name"/>
<text value="Middle"/>
<answer>
<valueString value="Yan"/>
</answer>
</item>
<item>
<linkId value="father-last-name"/>
<text value="Last"/>
<answer>
<valueString value="Lee"/>
</answer>
</item>
</item>
<item>
<linkId value="father-dob"/>
<text value="What is the father's date of birth?"/>
<answer>
<valueDate value="1984-02-27"/>
</answer>
</item>
<item>
<linkId value="father-birthplace"/>
<text
value="In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:"/>
<item>
<linkId value="father-birthplace-state"/>
<text value="State"/>
<answer>
<valueString value="NY"/>
</answer>
</item>
</item>
<item>
<linkId value="receive-wic"/>
<text
value="Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mothers-height"/>
<text value="What is your height?"/>
<item>
<linkId value="mothers-height-inches"/>
<text value="Inches"/>
<answer>
<valueQuantity>
<value value="65"/>
<unit value="[in_i]"/>
<system value="http://unitsofmeasure.org"/>
<code value="[in_i]"/>
</valueQuantity>
</answer>
</item>
</item>
<item>
<linkId value="mothers-prepregnancy-weight"/>
<text value="lbs"/>
<answer>
<valueQuantity>
<value value="180"/>
<unit value="[lb_av]"/>
<system value="http://unitsofmeasure.org"/>
<code value="[lb_av]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="mothers-smoking"/>
<text
value="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."/>
<item>
<linkId value="mothers-smoking-3-months-prior"/>
<text value="Three months before pregnancy"/>
<item>
<linkId value="mothers-smoking-3-months-prior-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-3-months-prior-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-1"/>
<text value="First three months of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-1-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-1-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-2"/>
<text value="Second three months of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-2-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-2-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-3"/>
<text value="Third trimester of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-3-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-3-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
</item>
</QuestionnaireResponse>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Practitioner/practitioner-vital-records-janet-seito"/>
<resource>
<Practitioner>
<id value="practitioner-vital-records-janet-seito"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Practitioner-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_practitioner-vital-records-janet-seito"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner practitioner-vital-records-janet-seito</b></p><a name="practitioner-vital-records-janet-seito"> </a><a name="hcpractitioner-vital-records-janet-seito"> </a><a name="hcpractitioner-vital-records-janet-seito-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/223347044</p><p><b>name</b>: Avery Jones </p><h3>Qualifications</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://snomed.info/sct 76231001}">Osteopath (occupation)</span></td></tr></table></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="223347044"/>
</identifier>
<name>
<family value="Jones"/>
<given value="Avery"/>
<suffix value="M.D."/>
</name>
<!-- Using the osteo code until PhinVads updates the value set with an active code for Medical Doctor -->
<qualification>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="76231001"/>
<display value="Osteopath (occupation)"/>
</coding>
</code>
</qualification>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Location/location-south-hospital"/>
<resource>
<Location>
<id value="location-south-hospital"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_location-south-hospital"> </a><p class="res-header-id"><b>Generated Narrative: Location location-south-hospital</b></p><a name="location-south-hospital"> </a><a name="hclocation-south-hospital"> </a><a name="hclocation-south-hospital-en-US"> </a><p><b>status</b>: Active</p><p><b>name</b>: South Hospital</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode HOSP}">Hospital</span></p></div>
</text>
<status value="active"/>
<name value="South Hospital"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="HOSP"/>
<display value="Hospital"/>
</coding>
</type>
</Location>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Organization/organization-south-hospital"/>
<resource>
<Organization>
<id value="organization-south-hospital"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_organization-south-hospital"> </a><p class="res-header-id"><b>Generated Narrative: Organization organization-south-hospital</b></p><a name="organization-south-hospital"> </a><a name="hcorganization-south-hospital"> </a><a name="hcorganization-south-hospital-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/5555512</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode HOSP}">Hospital</span></p><p><b>name</b>: South Hospital</p><p><b>telecom</b>: <a href="tel:+1-555-555-1111">+1-555-555-1111</a>, <a href="mailto:mail@southhospital.com">mail@southhospital.com</a></p><p><b>address</b>: 2100 North Ave Salt Lake City UT 84116 US </p></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="5555512"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="HOSP"/>
<display value="Hospital"/>
</coding>
</type>
<name value="South Hospital"/>
<telecom>
<system value="phone"/>
<value value="+1-555-555-1111"/>
</telecom>
<telecom>
<system value="email"/>
<value value="mail@southhospital.com"/>
</telecom>
<address>
<line value="2100 North Ave"/>
<city value="Salt Lake City"/>
<state value="UT"/>
<postalCode value="84116"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/RelatedPerson/relatedperson-mother-carmen-teresa-lee"/>
<resource>
<RelatedPerson>
<id value="relatedperson-mother-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/RelatedPerson-mother-gestational-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_relatedperson-mother-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee</b></p><a name="relatedperson-mother-carmen-teresa-lee"> </a><a name="hcrelatedperson-mother-carmen-teresa-lee"> </a><a name="hcrelatedperson-mother-carmen-teresa-lee-en-US"> </a><p><b>active</b>: true</p><p><b>patient</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode GESTM}">Gestational Mother</span></p><p><b>name</b>: Carmen Teresa Lee (Official)</p><p><b>gender</b>: Female</p><p><b>birthDate</b>: 1986-02-15</p></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2054-5"/>
<display value="Black or African American"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Black or African America"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2135-2"/>
<display value="Hispanic or Latino"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Hispanic or Latino"/>
</extension>
</extension>
<active value="true"/>
<patient>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="GESTM"/>
<display value="gestational mother"/>
</coding>
<text value="Gestational Mother"/>
</relationship>
<name>
<use value="official"/>
<family value="Lee"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<gender value="female"/>
<birthDate value="1986-02-15"/>
</RelatedPerson>
</resource>
</entry>
</Bundle>
IG © 2020+ IHE International. Package ihe.qrph.bfdr#1.1.0 based on FHIR 4.0.1. Generated 2024-07-09
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