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 QuestionnaireResponse: QuestionnaireResponse - Patient's Fetal Death Worksheet: Carmen Lee

Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee

version: versionId: id (PrimitiveType/QuestionnaireResponse.meta.versionId): element = id -> versionId=id[10]; Last updated: 2021-07-09 07:16:14+0000

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