{ "resourceType" : "Bundle", "id" : "fod-correction-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-notification-bundle"] }, "language" : "en", "identifier" : { "extension" : [{ "url" : "http://hl7.org/fhir/us/vr-common-library/StructureDefinition/CertificateNumber", "valueString" : "000999" }], "system" : "http://vitalrecords.example.gov/fod-notification", "value" : "IL-FOD-2026-0000999" }, "type" : "message", "timestamp" : "2026-09-10T09:12:00-05:00", "entry" : [{ "fullUrl" : "urn:uuid:b638f439-d271-423d-863a-987a44857511", "resource" : { "resourceType" : "MessageHeader", "id" : "IL-FOD-2026-0000999", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-message-header"] }, "language" : "en", "text" : { "status" : "generated", "div" : "
\n \n

\n Generated Narrative: MessageHeader IL-FOD-2026-0000999\n

\n \n \n
\n

\n

Profile: Fact of Death Message Header

\n
\n

\n event: Fact of Death Notification Event Codes: fact-of-death-notification (Fact of Death Notification)

\n

Destinations

\n \n \n \n \n \n \n \n \n \n \n \n \n \n
-\n Name\n \n Endpoint\n \n Receiver\n
*Example Health System\n https://ehr.example.org/fhir/$process-message\n Example Health System
\n

\n sender: Illinois Department of Public Health, Division of Vital Records

\n

Sources

\n \n \n \n \n \n \n \n \n \n \n \n
-\n Name\n \n Endpoint\n
*Illinois Vital Records Notification Service\n https://vitalrecords.example.gov/fod\n
\n

\n focus: Observation Date+time of death

\n
" }, "eventCoding" : { "system" : "http://somewhere.org/fhir/us/fod/CodeSystem/fod-notification-event-cs", "code" : "fact-of-death-notification" }, "destination" : [{ "name" : "Example Health System", "endpoint" : "https://ehr.example.org/fhir/$process-message", "receiver" : { "display" : "Example Health System" } }], "sender" : { "reference" : "urn:uuid:5d4c3b2a-1908-4716-8524-3f2e1d0c9b8a", "display" : "Illinois Department of Public Health, Division of Vital Records" }, "source" : { "name" : "Illinois Vital Records Notification Service", "endpoint" : "https://vitalrecords.example.gov/fod" }, "focus" : [{ "reference" : "urn:uuid:2b3c4d5e-6f70-4812-9345-6a7b8c9d0e1f" }] } }, { "fullUrl" : "urn:uuid:1a2b3c4d-5e6f-4708-9192-a3b4c5d6e7f9", "resource" : { "resourceType" : "Patient", "id" : "fod-decedent-hospital-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-decedent"] }, "language" : "en", "text" : { "status" : "generated", "div" : "
\n \n

\n Generated Narrative: Patient fod-decedent-hospital-example\n

\n \n \n
\n

\n

Profile: Fact of Death Decedent

\n
\n

Alice Rose Nakamura (official) Female, DoB: 1970-01-01 ( Social Security number)

\n
\n \n \n \n \n \n \n \n \n \n \n \n \n \n
Deceased:true
Alt. Name:Alice Whitfield (Name changed for Marriage)
Contact Detail\n
    \n
  • ph: 217-555-0142(Home)
    • \n
  • 1428 Elm Street Springfield IL 62704 US
    • \n
\n
\n
" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "SS" }] }, "system" : "http://hl7.org/fhir/sid/us-ssn", "value" : "999451234" }], "name" : [{ "use" : "official", "family" : "TestLast", "given" : ["TestFirst"] }, { "use" : "maiden", "family" : "Washington", "given" : ["TestFirst"] }], "telecom" : [{ "system" : "phone", "value" : "217-555-0142", "use" : "home" }], "gender" : "female", "birthDate" : "1970-01-01", "deceasedBoolean" : true, "address" : [{ "line" : ["1428 Elm Street"], "city" : "Springfield", "district" : "Sangamon", "state" : "IL", "postalCode" : "62704", "country" : "US" }] } }, { "fullUrl" : "urn:uuid:2b3c4d5e-6f70-4812-9345-6a7b8c9d0e1f", "resource" : { "resourceType" : "Observation", "id" : "fod-death-date-hospital-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-death-date"] }, "language" : "en", "text" : { "status" : "extensions", "div" : "
\n \n

\n Generated Narrative: Observation fod-death-date-hospital-example\n

\n \n \n
\n

\n

Profile: Fact of Death Death Date

\n
\n

\n Event Location: Location Springfield General Hospital

\n

\n status: Final

\n

\n code: Date+time of death

\n

\n subject: Alice Rose Nakamura (official) Female, DoB: 1970-01-01 ( Social Security number)

\n

\n value: 2026-08-29 14:22:00-0500

\n

\n method: Exact

\n
\n

\n component\n

\n

\n code: Date and time pronounced dead [US Standard Certificate of Death]

\n

\n value: 2026-08-29 14:35:00-0500

\n
\n
\n

\n component\n

\n

\n code: Location of death

\n

\n value: Death in hospital

\n
\n
" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/event-location", "valueReference" : { "reference" : "urn:uuid:3c4d5e6f-7081-4923-a456-7b8c9d0e1f20" } }], "status" : "final", "code" : { "coding" : [{ "system" : "http://loinc.org", "code" : "81956-5", "display" : "Date+time of death" }] }, "subject" : { "reference" : "urn:uuid:1a2b3c4d-5e6f-4708-9192-a3b4c5d6e7f9" }, "valueDateTime" : "2026-08-29T14:22:00-05:00", "method" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-date-of-death-determination-methods-cs", "code" : "exact", "display" : "Exact" }] }, "component" : [{ "code" : { "coding" : [{ "system" : "http://loinc.org", "code" : "80616-6", "display" : "Date and time pronounced dead [US Standard Certificate of Death]" }] }, "valueDateTime" : "2026-08-29T14:35:00-05:00" }, { "code" : { "coding" : [{ "system" : "http://loinc.org", "code" : "58332-8", "display" : "Location of death" }] }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "16983000", "display" : "Death in hospital" }] } }] } }, { "fullUrl" : "urn:uuid:3c4d5e6f-7081-4923-a456-7b8c9d0e1f20", "resource" : { "resourceType" : "Location", "id" : "fod-death-location-hospital-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-death-location"] }, "language" : "en", "text" : { "status" : "generated", "div" : "
\n \n

\n Generated Narrative: Location fod-death-location-hospital-example\n

\n \n \n
\n

\n

Profile: Fact of Death Death Location

\n
\n

\n name: Springfield General Hospital

\n

\n type: Death Location

\n

\n address: 800 North Rutledge Street Springfield IL 62702 US

\n
" }, "name" : "Springfield General Hospital", "type" : [{ "coding" : [{ "system" : "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-location-type-cs", "code" : "death" }] }], "address" : { "line" : ["800 North Rutledge Street"], "city" : "Springfield", "district" : "Sangamon", "state" : "IL", "postalCode" : "62702", "country" : "US" } } }, { "fullUrl" : "urn:uuid:5d4c3b2a-1908-4716-8524-3f2e1d0c9b8a", "resource" : { "resourceType" : "Organization", "id" : "fod-source-organization-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-source-organization"] }, "language" : "en", "text" : { "status" : "generated", "div" : "
\n \n

\n Generated Narrative: Organization fod-source-organization-example\n

\n \n \n
\n

\n

Profile: Fact of Death Source Organization

\n
\n

\n identifier: http://vitalrecords.example.gov/jurisdiction-id/IL

\n

\n active: true

\n

\n type: Government

\n

\n name: Illinois Department of Public Health, Division of Vital Records

\n

\n telecom: ph: 217-555-0100

\n

\n address: 925 East Ridgely Avenue Springfield IL 62702 US

\n
" }, "identifier" : [{ "system" : "http://vitalrecords.example.gov/jurisdiction-id", "value" : "IL" }], "active" : true, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "govt", "display" : "Government" }] }], "name" : "Illinois Department of Public Health, Division of Vital Records", "telecom" : [{ "system" : "phone", "value" : "217-555-0100" }], "address" : [{ "line" : ["925 East Ridgely Avenue"], "city" : "Springfield", "state" : "IL", "postalCode" : "62702", "country" : "US" }] } }, { "fullUrl" : "urn:uuid:4e5f6071-8293-4a45-b567-8c9d0e1f2031", "resource" : { "resourceType" : "Provenance", "id" : "fod-provenance-hospital-example", "meta" : { "profile" : ["http://somewhere.org/fhir/us/fod/StructureDefinition/fod-provenance"] }, "language" : "en", "text" : { "status" : "generated", "div" : "
\n \n

\n Generated Narrative: Provenance fod-provenance-hospital-example\n

\n \n \n
\n

\n

Profile: Fact of Death Provenance

\n
\n

Provenance for Observation Date+time of death

\n

Summary

\n \n \n \n \n \n \n \n \n \n
Occurrence2026-09-01
Recorded2026-09-10 09:12:00-0500
\n

\n Agents\n

\n \n \n \n \n \n \n \n \n \n
\n Type\n \n who\n
\n Author\n \n Organization Illinois Department of Public Health, Division of Vital Records\n
\n
" }, "target" : [{ "reference" : "urn:uuid:2b3c4d5e-6f70-4812-9345-6a7b8c9d0e1f" }], "occurredDateTime" : "2026-09-01", "recorded" : "2026-09-10T09:12:00-05:00", "agent" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type", "code" : "author" }] }, "who" : { "reference" : "urn:uuid:5d4c3b2a-1908-4716-8524-3f2e1d0c9b8a" } }] } }] }