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

## Example Bundle: Bundle - Provider Fetal Death Report - Fetus Not Named

Document Details

Generated Narrative: Bundle Provider fetal death report Document

version: versionId: id (PrimitiveType/Bundle.meta.versionId): native = id -> 4; Last updated: 2023-08-29 06:22:00+0000

Profile: Bundle - Document Birth and Fetal Death

Final Document at 2019-01-09 by Practitioner - Vital Records (Jessica Leung) for Patient - Decedent Fetus (Fetus Not Named) in encounter Encounter - Maternity (Carmen Teresa Lee)

Document Subject

Document Content

## Mother (prenatal) Section on the Fetal Death Report

## Medical and Health Information on the Fetal Death Report

## Fetal delivery information section on the Fetal Death Report

## Mother Administrative Section on the Fetal Death Report

## Mother's QuestionnaireResponse Section

## Additional Resources Included in Document

Entry 1 - fullUrl = http://example.org/fhir/Composition/composition-provider-fetal-death-not-named

Resource Composition:

> 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

Entry 2 - fullUrl = http://example.org/fhir/Patient/patient-decedent-fetus-not-named

Resource Patient:

> 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)

Entry 3 - fullUrl = http://example.org/fhir/Encounter/encounter-maternity-carmen-teresa-lee

Resource Encounter:

> Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee

> Not done yet

Entry 4 - fullUrl = http://example.org/fhir/Practitioner/practitioner-vital-records-jessica-leung

Resource Practitioner:

> Generated Narrative: Practitioner practitioner-vital-records-jessica-leung

> identifier: NPI/223347055

> name: Leung Jessica

> ### Qualifications

> - | Code
> * | Birth Clerk

Entry 5 - fullUrl = http://example.org/fhir/Patient/patient-mother-carmen-teresa-lee

Resource Patient:

> 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)
> 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
> US Core Race Extension: | ombCategory: Race & Ethnicity - CDC 2054-5: Black or African American text: Black or African America

Entry 6 - fullUrl = http://example.org/fhir/Observation/observation-planned-to-deliver-at-home-not-named

Resource Observation:

> 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

Entry 7 - fullUrl = http://example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee

Resource Observation:

> 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

Entry 8 - fullUrl = http://example.org/fhir/Observation/observation-last-menstrual-period-carmen-teresa-lee

Resource Observation:

> 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

Entry 9 - fullUrl = http://example.org/fhir/Observation/observation-number-births-now-living-carmen-teresa-lee

Resource Observation:

> 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

Entry 10 - fullUrl = http://example.org/fhir/Observation/observation-number-births-now-dead-carmen-teresa-lee

Resource Observation:

> 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

Entry 11 - fullUrl = http://example.org/fhir/Observation/observation-date-of-last-live-birth-carmen-teresa-lee

Resource Observation:

> 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

Entry 12 - fullUrl = http://example.org/fhir/Observation/observation-mother-height-carmen-teresa-lee

Resource Observation:

> 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]')

Entry 13 - fullUrl = http://example.org/fhir/Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee

Resource Observation:

> 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]')

Entry 14 - fullUrl = http://example.org/fhir/Observation/observation-mother-received-wic-food-carmen-teresa-lee

Resource Observation:

> 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

Entry 15 - fullUrl = http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee

Resource Observation:

> 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

Entry 16 - fullUrl = http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee

Resource Observation:

> 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

Entry 17 - fullUrl = http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee

Resource Observation:

> 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

Entry 18 - fullUrl = http://example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee

Resource Observation:

> 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

Entry 19 - fullUrl = http://example.org/fhir/Observation/observation-number-previous-cesareans-carmen-teresa-lee

Resource Observation:

> 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

Entry 20 - fullUrl = http://example.org/fhir/Observation/observation-fetal-presentation-not-named

Resource Observation:

> 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)

Entry 21 - fullUrl = http://example.org/fhir/Procedure/procedure-final-route-method-delivery-not-named

Resource Procedure:

> Generated Narrative: Procedure procedure-final-route-method-delivery-not-named

> status: Completed

> code: Spontaneous vaginal delivery

> subject: Patient - Mother (Carmen Teresa Lee)

Entry 22 - fullUrl = http://example.org/fhir/Observation/observation-birth-weight-not-named

Resource Observation:

> 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')

Entry 23 - fullUrl = http://example.org/fhir/Observation/observation-gestational-age-at-delivery-not-named

Resource Observation:

> 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')

Entry 24 - fullUrl = http://example.org/fhir/Condition/condition-fetal-death-cause-or-condition-not-named

Resource Condition:

> 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)

Entry 25 - fullUrl = http://example.org/fhir/Condition/condition-fetal-death-other-significant-cause-not-named

Resource Condition:

> 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)

Entry 26 - fullUrl = http://example.org/fhir/Observation/observation-fetal-death-time-point-not-named

Resource Observation:

> 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)

Entry 27 - fullUrl = http://example.org/fhir/Observation/observation-autopsy-performed-not-named

Resource Observation:

> 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)

Entry 28 - fullUrl = http://example.org/fhir/Observation/observation-histological-placental-exam-performed-not-named

Resource Observation:

> 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

Entry 29 - fullUrl = http://example.org/fhir/Observation/observation-autopsy-histological-exam-results-used-not-named

Resource Observation:

> 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

Entry 30 - fullUrl = http://example.org/fhir/Observation/observation-parent-education-level-carmen-teresa-lee

Resource Observation:

> 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

Entry 31 - fullUrl = http://example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee

Resource QuestionnaireResponse:

> 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

Entry 32 - fullUrl = http://example.org/fhir/Practitioner/practitioner-vital-records-janet-seito

Resource Practitioner:

> Generated Narrative: Practitioner practitioner-vital-records-janet-seito

> identifier: NPI/223347044

> name: Avery Jones

> ### Qualifications

> - | Code
> * | Osteopath (occupation)

Entry 33 - fullUrl = http://example.org/fhir/Location/location-south-hospital

Resource Location:

> Generated Narrative: Location location-south-hospital

> status: Active

> name: South Hospital

> type: Hospital

Entry 34 - fullUrl = http://example.org/fhir/Organization/organization-south-hospital

Resource Organization:

> Generated Narrative: Organization organization-south-hospital

> identifier: NPI/5555512

> active: true

> type: Hospital

> name: South Hospital

> > contact

> > telecom: +1-555-555-1111, mail@southhospital.com

> > address: 2100 North Ave Salt Lake City UT 84116 US

Entry 35 - fullUrl = http://example.org/fhir/RelatedPerson/relatedperson-mother-carmen-teresa-lee

Resource RelatedPerson:

> 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