HL7 PT FHIR Implementation Guide: Noticia de Nascimento
0.0.1 - STU1 Portugal flag

HL7 PT FHIR Implementation Guide: Noticia de Nascimento, published by HL7 Portugal. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-pt/obs-neonat-ig/ and changes regularly. See the Directory of published versions

Example Bundle: exemploNN

Document Details

Generated Narrative: Bundle Noticia de Nascimento de recém-nascido


Document Content

History of Medication use Narrative

Pregnancy related history Narrative

Labor and delivery process Narrative

Newborn delivery information

Newborn screening test results panel - Point of Care

History of Immunization Narrative

Hospital discharge follow-up Narrative

Primary care hospital (environment)


Additional Resources Included in Document


Entry 1 - fullUrl = http://example.org/Composition/compNN

Resource Composition:

Generated Narrative: Composition compNN

status: Final

type: Birth certificate

encounter: Encounter: identifier = 18001555; status = finished; class = Internamento (Tipos de episódio CodeSystem#INT); serviceType =

date: 2021-09-01

author: HCP

title: Noticia de Nascimento de recém-nascido


Entry 2 - fullUrl = http://example.org/Procedure/BirthNN

Resource Procedure:

Generated Narrative: Procedure BirthNN

status: Completed

code: Delivery of vertex presentation (procedure)

subject: NOME DE TESTE (no stated gender), DoB: 1989-07-30 ( http://example#1234567)

encounter: Encounter: status = finished; class = Internamento (Tipos de episódio CodeSystem#INT)

Performers

-Actor
*PractitionerRole Obstetrician

Entry 3 - fullUrl = http://example.org/Encounter/episodioInt

Resource Encounter:

Generated Narrative: Encounter episodioInt

status: completed

class: Internamento


Entry 4 - fullUrl = http://example.org/Organization/destino

Resource Organization:

Generated Narrative: Organization destino

identifier: 2010491

name: USF ESCARIZ


Entry 5 - fullUrl = http://example.org/Patient/mother

Resource Patient:

Generated Narrative: Patient mother

NOME DE TESTE (no stated gender), DoB: 1989-07-30 ( http://example#1234567)


Contact DetailMORADA DE TESTE
Patient Nationality:
  • code: Portugal

Entry 6 - fullUrl = http://example.org/Encounter/episodio

Resource Encounter:

Generated Narrative: Encounter episodio

identifier: 18001555

status: completed

class: Internamento

serviceType: No display for Encounter.serviceType (concept: )

serviceProvider: Organization CH ENTRE DOURO E VOUGA


Entry 7 - fullUrl = http://example.org/Organization/inst

Resource Organization:

Generated Narrative: Organization inst

name: CH ENTRE DOURO E VOUGA


Entry 8 - fullUrl = http://example.org/Observation/pregnancyNN

Resource Observation:

Generated Narrative: Observation pregnancyNN

status: Final

code: Pregnancy (finding)

subject: Anonymous Patient Female, DoB Unknown

effective: 2024-08-01 10:00:00+0000


Entry 9 - fullUrl = http://example.org/Patient/newBornNN

Resource Patient:

Generated Narrative: Patient newBornNN

Anonymous Patient Female, DoB Unknown



Entry 10 - fullUrl = http://example.org/Observation/body-weigth-example

Resource Observation:

Generated Narrative: Observation body-weigth-example

status: Final

category: Vital Signs

code: Body weight

subject: Anonymous Patient Female, DoB Unknown

effective: 2024-08-01 10:00:00+0000

value: 3250 gram(s) (Details: UCUM codeg = 'g')


Entry 11 - fullUrl = http://example.org/Observation/length-example

Resource Observation:

Generated Narrative: Observation length-example

status: Final

category: Vital Signs

code: Body height

subject: Anonymous Patient Female, DoB Unknown

effective: 2024-08-01 10:00:00+0000

value: 50 cm(s) (Details: UCUM codecm = 'cm')


Entry 12 - fullUrl = http://example.org/Organization/childhealthsurveilance-ex

Resource Organization:

Generated Narrative: Organization childhealthsurveilance-ex

identifier: http:/example.org/4


Entry 13 - fullUrl = http://example.org/Observation/puerperium-ex

Resource Observation:

Generated Narrative: Observation puerperium-ex

identifier: http:/example.org/4

status: Final

code: Puerperium observable (observable entity)

value: Normal puerperium (finding)


Entry 14 - fullUrl = http://example.org/Immunization/vaccNN-antid

Resource Immunization:

Generated Narrative: Immunization vaccNN-antid

status: Completed

vaccineCode: Product containing only human anti-D immunoglobulin (medicinal product)

lotNumber: xyz-123

patient: Anonymous Patient Female, DoB Unknown

occurrence: 2024-08-01 10:00:00+0000


Entry 15 - fullUrl = http://example.org/Immunization/vaccNN-hepb

Resource Immunization:

Generated Narrative: Immunization vaccNN-hepb

status: Completed

vaccineCode: Vaccine product containing only Hepatitis B virus antigen (medicinal product)

lotNumber: abc-9878

patient: Anonymous Patient Female, DoB Unknown

occurrence: 2024-08-01 10:00:00+0000


Entry 16 - fullUrl = http://example.org/Immunization/vaccNN-bcg

Resource Immunization:

Generated Narrative: Immunization vaccNN-bcg

status: Completed

vaccineCode: Vaccine product containing only live attenuated Mycobacterium bovis antigen (medicinal product)

lotNumber: ghy-123/2024

patient: Anonymous Patient Female, DoB Unknown

occurrence: 2024-08-01 10:00:00+0000


Entry 17 - fullUrl = http://example.org/Observation/apgar-example

Resource Observation:

Generated Narrative: Observation apgar-example

status: Final

code: Apgar score (assessment scale)

component

code: Apgar score at 1 minute (observable entity)

value: 7

component

code: Apgar score at 5 minutes (observable entity)

value: 9

component

code: Apgar score at 10 minutes (observable entity)

value: 10


Entry 18 - fullUrl = http://example.org/Observation/congenital-example

Resource Observation:

Generated Narrative: Observation congenital-example

status: Final

code: Congenital anomalies of the newborn [US Standard Certificate of Live Birth]

value: No abnormality detected - examination result


Entry 19 - fullUrl = http://example.org/Observation/pupillary-example

Resource Observation:

Generated Narrative: Observation pupillary-example

status: Final

code: Pupil reaction

component

code: Right pupil Pupillary response

value: No abnormality detected - examination result

component

code: Left pupil Pupillary response

value: No abnormality detected - examination result


Entry 20 - fullUrl = http://example.org/Observation/cephalic-perimeter-example

Resource Observation:

Generated Narrative: Observation cephalic-perimeter-example

status: Final

category: Vital Signs

code: Head Occipital-frontal circumference

subject: Anonymous Patient Female, DoB Unknown

effective: 2024-08-01 10:00:00+0000

value: 50.1 cm(s) (Details: UCUM codecm = 'cm')


Entry 21 - fullUrl = http://example.org/PractitionerRole/ObsRole

Resource PractitionerRole:

Generated Narrative: PractitionerRole ObsRole

code: Obstetrician