Generated Narrative: Composition composition-provider-fetal-death-not-named identifier: z03eab8c-11e8-4d0c-ad2a-b385395e27da status: Final type: U.S. standard report of fetal death - 2003 revision encounter: Encounter - Maternity (Carmen Teresa Lee) date: 2019-01-09 author: Practitioner - Vital Records (Jessica Leung) title: Provider fetal death report Document
U.S. standard report of fetal death - 2003 revision
Patient - Decedent Fetus (Fetus Not Named)
Encounter - Maternity (Carmen Teresa Lee)
Practitioner - Vital Records (Jessica Leung)
Mother (prenatal) Section on the Fetal Death Report
Observation - Planned to Deliver at Home (Carmen Teresa Lee)
Observation - Date of First Prenatal Care Visit (Carmen Teresa Lee)
Observation - Last Menstrual Period (Carmen Teresa Lee)
Observation - Number Births Now Living (Carmen Teresa Lee)
Observation - Number Births Now Dead (Carmen Teresa Lee)
Observation - Date of Last Live Birth (Carmen Teresa Lee)
Observation - Mother Height (Carmen Teresa Lee)
Observation - Mother Prepregnancy Weight (Carmen Teresa Lee)
Observation - Mother Received WIC Food (Carmen Teresa Lee)
Observation - Cigarette Smoking Before/During Pregnancy (3 months prior: Carmen Teresa Lee)
Observation - Cigarette Smoking Before/During Pregnancy (first 3 months: Carmen Teresa Lee)
Observation - Cigarette Smoking Before/During Pregnancy (last 3 months: Carmen Teresa Lee)
Observation - Cigarette Smoking Before/During Pregnancy (second 3 months: Carmen Teresa Lee)
Medical and Health Information on the Fetal Death Report
Observation - Number Previous Cesareans (Carmen Teresa Lee)
Observation - Fetal Presentation (Fetus Not Named)
Procedure - Final Route and Method of Delivery (Fetus Not Named)
Fetal delivery information section on the Fetal Death Report
Fetal delivery information Document [US Standard Report of Fetal Death]
Observation - Birth Weight (Fetus Not Named)
Observation - Gestational Age at Delivery (Fetus Not Named)
Condition - Fetal Death Cause or Condition (Fetus Not Named)
Example of Condition-fetal-death-other-significant-cause profile (Fetus Not Named)
Example of Observation-estimated-fetal-death-time-point profile (Fetus Not Named)
Example of Observation-autopsy-performed profile (Fetus Not Named)
Observation - Histological Placental Exam Performed (Fetus Not Named)
Observation - Autopsy or Histological Exam Results Used
Mother Administrative Section on the Fetal Death Report
Observation - Parent Education Level (Carmen Teresa Lee)
QuestionnaireResponse - Patient's Worksheet for Fetal Death Report
Generated Narrative: Patient patient-decedent-fetus-not-named UNK Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, )) Deceased: true Patient Birth Place Ann Arbor MI 48103 US Core Birth Sex Extension F Extension - Patient Fetal Death - Vital Records SNOMED CT (all versions) 276507005: Fetal death (event)
Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee identifier: http://hospital.smarthealthit.org/8937015 status: Finished class: ActCode IMP: inpatient encounter type: Under Observation or Inpatient Care Services (Including Admission and Discharge Services) subject: Patient - Mother (Carmen Teresa Lee) Participants - Type Individual * Birth attendant [Extended Identifier] Practitioner - Vital Records (Janet Seito, MD) period: 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700 Locations - Location PhysicalType * Location - US Core Location (South Hospital) Hospital serviceProvider: Organization - US Core Organization (South Hospital Organization)
Under Observation or Inpatient Care Services (Including Admission and Discharge Services)
Practitioner - Vital Records (Janet Seito, MD)
Location - US Core Location (South Hospital)
Organization - US Core Organization (South Hospital Organization)
Generated Narrative: Practitioner practitioner-vital-records-jessica-leung identifier: NPI/223347055 name: Leung Jessica Qualifications - Code * Birth Clerk
Generated Narrative: Patient patient-mother-carmen-teresa-lee Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) Alt. Name: Carmen Teresa Santos (Name changed for Marriage) Contact Detail 3670 Miller Road Ann Arbor MI 48103 US (home) Links: Also see: RelatedPerson Carmen Teresa Lee (official) <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: ombCategory: Race & Ethnicity - CDC 2135-2: Hispanic or Latino text: Hispanic or Latino Patient Birth Place PR US Core Birth Sex Extension F <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: ombCategory: Race & Ethnicity - CDC 2054-5: Black or African American text: Black or African America
Generated Narrative: Observation observation-planned-to-deliver-at-home-not-named status: Final code: Planned to deliver at home? subject: Patient - Decedent Fetus (Fetus Not Named) focus: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: false
Mother Planned to deliver at home [US Standard Certificate of Live Birth]
Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee status: Final code: Date of first prenatal care visit subject: Patient - Decedent Fetus (Fetus Not Named) focus: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 2018-05-18
Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee status: Final code: Last menstrual period start date subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 2018-04-18
Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee status: Final code: [#] Births.still living subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 1
Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee status: Final code: Previous live births now dead # subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 0
Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee status: Final code: Date of last live birth subject: Patient - Decedent Fetus (Fetus Not Named) focus: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 2016-01-28
Generated Narrative: Observation observation-mother-height-carmen-teresa-lee status: Final category: Vital Signs code: Body height Measured subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-01-10 performer: Practitioner Avery Jones value: 65 [in_i] (Details: UCUM code[in_i] = '[in_i]')
Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee status: Final category: Vital Signs code: Body weight --pre current pregnancy subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-05-20 performer: Practitioner Avery Jones value: 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')
Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee status: Final code: Did mother get WIC food for herself during this pregnancy? subject: Patient - Decedent Fetus (Fetus Not Named) focus: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: No
Did mother get WIC food for herself during this pregnancy?
Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee status: Final code: In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX] subject: Patient - Mother (Carmen Teresa Lee) focus: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: 0
In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]
Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee status: Final code: Cigarettes smoked per day by Mother--1st trimester subject: Patient - Mother (Carmen Teresa Lee) focus: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: 0
Cigarettes smoked per day by Mother--1st trimester
Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee status: Final code: Cigarettes smoked per day by Mother--2nd trimester subject: Patient - Mother (Carmen Teresa Lee) focus: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: 1
Cigarettes smoked per day by Mother--2nd trimester
Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee status: Final code: In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX] subject: Patient - Mother (Carmen Teresa Lee) focus: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: 0
In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]
Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee status: Final code: Previous cesarean deliveries # subject: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Practitioner Avery Jones value: 1
Generated Narrative: Observation observation-fetal-presentation-not-named status: Final code: Fetal presentation--at birth [US Standard Certificate of Live Birth] subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: Breech presentation (finding)
Fetal presentation--at birth [US Standard Certificate of Live Birth]
Generated Narrative: Procedure procedure-final-route-method-delivery-not-named status: Completed code: Spontaneous vaginal delivery subject: Patient - Mother (Carmen Teresa Lee) performed: 2019-01-19 18:00:00-0700 --> 2019-01-19 18:23:00-0700
Generated Narrative: Observation observation-birth-weight-not-named status: Final category: Vital Signs code: Birth weight Measured subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-02-10 performer: Practitioner Avery Jones value: 1530 g (Details: UCUM codeg = 'g')
Generated Narrative: Observation observation-gestational-age-at-delivery-not-named status: Final code: Gestational age Estimated subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: 20 wk (Details: UCUM codewk = 'wk')
Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named category: Encounter Diagnosis, Initiating cause or condition of fetal death [US Standard Report of Fetal Death] code: Premature rupture of membranes (disorder) subject: Patient - Decedent Fetus (Fetus Not Named)
Initiating cause or condition of fetal death [US Standard Report of Fetal Death]
Premature rupture of membranes (disorder)
Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named category: Encounter Diagnosis, Other significant causes or conditions of fetal death [US Standard Report of Fetal Death] code: Placental insufficiency (disorder) subject: Patient - Decedent Fetus (Fetus Not Named)
Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]
Generated Narrative: Observation observation-fetal-death-time-point-not-named status: Final code: Estimated timing of fetal death [US Standard Report of Fetal Death] subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: Fetal intrapartum death after first assessment (event)
Estimated timing of fetal death [US Standard Report of Fetal Death]
Fetal intrapartum death after first assessment (event)
Generated Narrative: Observation observation-autopsy-performed-not-named status: Final code: Autopsy was performed subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: Autopsy performed (situation)
Generated Narrative: Observation observation-histological-placental-exam-performed-not-named status: Final code: Histological placental examination was performed [US Standard Report of Fetal Death] subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: Performed
Histological placental examination was performed [US Standard Report of Fetal Death]
Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named status: Final code: Autopsy or histological placental examination results were used [US Standard Report of Fetal Death] subject: Patient - Decedent Fetus (Fetus Not Named) effective: 2019-12-02 performer: Practitioner Avery Jones value: Yes
Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]
Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee status: Final code: Highest level of education Mother subject: Patient - Decedent Fetus (Fetus Not Named) focus: Patient - Mother (Carmen Teresa Lee) effective: 2019-12-02 performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, )) value: 9th through 12th grade; no diploma
Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee LinkID Text Definition Answer QuestionnaireResponse-patients-fetal-death-carmen-lee Questionnaire:Questionnaire - Patient's Worksheet for the Report of Fetal Death mother-current-legal-name What is your current legal name? mother-first-name First Carmen mother-middle-name Middle Teresa mother-last-name Last Lee mother-address Where do you usually live - that is - where is your household/residence located? mother-nbr-street Complete number and street (do not enter rural route numbers) 3670 Miller Road mother-city City, Town, or Location mother-state State (or U.S. Territory, Canadian Province) MI mother-zip Zip Code 48103 inside-city-limits Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)? expandedYes-NoIndicator N: No mother-mail What is your mailing address mother-mail-same Same as residence [Go to next question] true mother-dob What is your date of birth? 1986-02-15 mother-birthplace In what State, U.S. territory, or foreign country were you born? Please specify one of the following: mother-birthplace-territory or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas PR mother-education 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). unknown PHC1449: 9th through 12th grade; no diploma mother-ethnicity Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the “No” box. If Spanish/Hispanic/Latina, check the appropriate box. mother-shl Are you Spanish/Hispanic/Latina Race & Ethnicity - CDC 2135-2: Hispanic or Latino mother-race What is your race? (Please check one or more races to indicate what you consider yourself to be). mother-race-category Race categories Race & Ethnicity - CDC 2054-5: Black or African American father-current-legal-name What is the current legal name of your baby's father? father-first-name First Tom father-middle-name Middle Yan father-last-name Last Lee father-dob What is the father's date of birth? 1984-02-27 father-birthplace In what State, U.S. territory, or foreign country was the father born? Please specify one of the following: father-birthplace-state State NY receive-wic Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy? expandedYes-NoIndicator N: No mothers-height What is your height? mothers-height-inches Inches 65 [in_i] (Details: UCUM code[in_i] = '[in_i]') mothers-prepregnancy-weight lbs 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]') mothers-smoking 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. mothers-smoking-3-months-prior Three months before pregnancy mothers-smoking-3-months-prior-cig # of cigarettes* 0 mothers-smoking-3-months-prior-pck # of packs 0 mothers-smoking-trimester-1 First three months of pregnancy mothers-smoking-trimester-1-cig # of cigarettes* 0 mothers-smoking-trimester-1-pck # of packs 0 mothers-smoking-trimester-2 Second three months of pregnancy mothers-smoking-trimester-2-cig # of cigarettes* 0 mothers-smoking-trimester-2-pck # of packs 0 mothers-smoking-trimester-3 Third trimester of pregnancy mothers-smoking-trimester-3-cig # of cigarettes* 0 mothers-smoking-trimester-3-pck # of packs 0 Documentation for this format
Where do you usually live - that is - where is your household/residence located?
Complete number and street (do not enter rural route numbers)
State (or U.S. Territory, Canadian Province)
Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?
In what State, U.S. territory, or foreign country were you born? Please specify one of the following:
or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas
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).
Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the “No” box. If Spanish/Hispanic/Latina, check the appropriate box.
What is your race? (Please check one or more races to indicate what you consider yourself to be).
What is the current legal name of your baby's father?
In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?
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.
Generated Narrative: Practitioner practitioner-vital-records-janet-seito identifier: NPI/223347044 name: Avery Jones Qualifications - Code * Osteopath (occupation)
Generated Narrative: Location location-south-hospital status: Active name: South Hospital type: Hospital
Generated Narrative: Organization organization-south-hospital identifier: NPI/5555512 active: true type: Hospital name: South Hospital telecom: +1-555-555-1111, mail@southhospital.com address: 2100 North Ave Salt Lake City UT 84116 US
Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee active: true patient: Patient - Decedent Fetus (Fetus Not Named) relationship: Gestational Mother name: Carmen Teresa Lee (Official) gender: Female birthDate: 1986-02-15