/
submission_record_537_example.json
1444 lines (1444 loc) · 41.1 KB
/
submission_record_537_example.json
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{
"resourceType": "Bundle",
"id": "aa7fd35b-9ab0-419c-84c3-8e63a527c203",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-certificate-document"
]
},
"identifier": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/CertificateNumber",
"valueString": "537"
}
],
"system": "http://nchs.cdc.gov/vrdr_id",
"value": "2022MA000537"
},
"type": "document",
"timestamp": "2022-06-30T11:18:03.800559-04:00",
"entry": [
{
"fullUrl": "urn:uuid:154b4574-0a26-45ce-a678-603742f9b3c7",
"resource": {
"resourceType": "Composition",
"id": "154b4574-0a26-45ce-a678-603742f9b3c7",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-certificate"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/FilingFormat",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-filing-format-cs",
"code": "electronic",
"display": "Electronic"
}
]
}
}
],
"status": "final",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "64297-5",
"display": "Death certificate"
}
]
},
"subject": {
"reference": "urn:uuid:30861315-1c29-43a5-bedd-f31923ec92e4"
},
"author": [
{
"reference": "urn:uuid:7ee40610-ea56-480c-9e05-5aeb3c8869cf"
}
],
"title": "Death Certificate",
"attester": [
{
"mode": "legal",
"party": {
"reference": "urn:uuid:7ee40610-ea56-480c-9e05-5aeb3c8869cf"
}
}
],
"event": [
{
"code": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "103693007",
"display": "Diagnostic procedure (procedure)"
}
]
}
],
"detail": [
{
"reference": "urn:uuid:5e56ae0d-7923-4bcf-b1a4-8dee0292926d"
}
]
}
],
"section": [
{
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-document-section-cs",
"code": "DecedentDemographics"
}
]
},
"entry": [
{
"reference": "urn:uuid:30861315-1c29-43a5-bedd-f31923ec92e4"
},
{
"reference": "urn:uuid:5ec296fb-046c-4646-ae8e-5af67f3871b0"
},
{
"reference": "urn:uuid:4c2d4c08-1759-4471-9a68-33c8d4039cee"
},
{
"reference": "urn:uuid:b9cb44c2-6f0c-4ccf-abdb-6389fa52e145"
},
{
"reference": "urn:uuid:d6e8a27f-adf9-49f7-8613-19579ba0e882"
},
{
"reference": "urn:uuid:75e2efe8-55a6-4aea-88ed-fdc69c180c09"
}
]
},
{
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-document-section-cs",
"code": "DeathCertification"
}
]
},
"entry": [
{
"reference": "urn:uuid:7ee40610-ea56-480c-9e05-5aeb3c8869cf"
},
{
"reference": "urn:uuid:5e56ae0d-7923-4bcf-b1a4-8dee0292926d"
},
{
"reference": "urn:uuid:09e72f10-2fcd-4dea-8d3c-e9f6aa363b85"
},
{
"reference": "urn:uuid:9a4323a2-8b58-40c7-a965-ae6115602878"
},
{
"reference": "urn:uuid:062ea6da-289c-4ea3-b64b-bc4d8381b596"
}
]
},
{
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-document-section-cs",
"code": "DeathInvestigation"
}
]
},
"entry": [
{
"reference": "urn:uuid:c8e35756-dd07-4680-8e48-6d5c62d24a6e"
},
{
"reference": "urn:uuid:7a7795a2-8bee-4b96-bd11-c936e0ff11dd"
},
{
"reference": "urn:uuid:3eed2c94-e28f-4015-b5b9-c7e030293cb3"
},
{
"reference": "urn:uuid:c0395467-c3a6-4f8d-8b82-f4669b3e88e4"
},
{
"reference": "urn:uuid:d977da0b-a164-438e-a320-f8434eeee12f"
},
{
"reference": "urn:uuid:1c9a83ed-ff1c-4b27-9267-c9237f3351ab"
}
]
},
{
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-document-section-cs",
"code": "DecedentDisposition"
}
]
},
"entry": [
{
"reference": "urn:uuid:44d58fa7-9806-486c-b0e6-d582369cdd0c"
}
]
}
]
}
},
{
"fullUrl": "urn:uuid:30861315-1c29-43a5-bedd-f31923ec92e4",
"resource": {
"resourceType": "Patient",
"id": "30861315-1c29-43a5-bedd-f31923ec92e4",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-decedent"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/NVSS-SexAtDeath",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female",
"display": "Female"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"state": "CT",
"country": "US"
}
}
],
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "SB",
"display": "Social Beneficiary Identifier"
}
]
},
"system": "http://hl7.org/fhir/sid/us-ssn",
"value": "531869507"
}
],
"name": [
{
"use": "official",
"family": "Hilty",
"given": [
"Twila",
"R",
"Roxanne"
]
}
],
"_birthDate": {
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Year",
"valueUnsignedInt": 2002
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Month",
"valueUnsignedInt": 1
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Day",
"valueUnsignedInt": 1
}
],
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/PartialDate"
}
]
},
"address": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/StreetNumber",
"valueString": "4437"
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/PreDirectional",
"valueString": "North"
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/StreetName",
"valueString": "Charles"
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/StreetDesignator",
"valueString": "Avenue"
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/PostDirectional",
"valueString": "Southeast"
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/UnitOrAptNumber",
"valueString": "Apt 2B"
}
],
"line": [
"4437 North Charles Avenue Southeast Apt 2B"
],
"city": "Hartford",
"_city": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/CityCode",
"valuePositiveInt": 37000
}
]
},
"district": "Hartford",
"_district": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/DistrictCode",
"valuePositiveInt": 3
}
]
},
"state": "CT",
"_state": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Location-Jurisdiction-Id",
"valueString": "CT"
}
]
},
"postalCode": "06107",
"country": "US"
}
],
"maritalStatus": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/BypassEditFlag",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-bypass-edit-flag-cs",
"code": "0",
"display": "Edit Passed"
}
]
}
}
],
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "S",
"display": "Never Married"
}
]
}
}
},
{
"fullUrl": "urn:uuid:7ee40610-ea56-480c-9e05-5aeb3c8869cf",
"resource": {
"resourceType": "Practitioner",
"id": "7ee40610-ea56-480c-9e05-5aeb3c8869cf",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-certifier"
]
}
}
},
{
"fullUrl": "urn:uuid:5e56ae0d-7923-4bcf-b1a4-8dee0292926d",
"resource": {
"resourceType": "Procedure",
"id": "5e56ae0d-7923-4bcf-b1a4-8dee0292926d",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-certification"
]
},
"status": "completed",
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "103693007",
"display": "Diagnostic procedure"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "308646001",
"display": "Death certification"
}
]
},
"subject": {
"reference": "urn:uuid:30861315-1c29-43a5-bedd-f31923ec92e4"
},
"performer": [
{
"function": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "434651000124107",
"display": "Certifying physician-To the best of my knowledge, death occurred due to the cause(s) and manner stated."
}
]
},
"actor": {
"reference": "urn:uuid:7ee40610-ea56-480c-9e05-5aeb3c8869cf"
}
}
]
}
},
{
"fullUrl": "urn:uuid:c8e35756-dd07-4680-8e48-6d5c62d24a6e",
"resource": {
"resourceType": "Observation",
"id": "c8e35756-dd07-4680-8e48-6d5c62d24a6e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-date"
]
},
"status": "final",
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "81956-5",
"display": "Date+time of death"
}
]
},
"subject": {
"reference": "urn:uuid:30861315-1c29-43a5-bedd-f31923ec92e4"
},
"_valueDateTime": {
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Year",
"valueUnsignedInt": 2022
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Month",
"valueUnsignedInt": 1
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Day",
"valueUnsignedInt": 10
},
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Date-Time",
"valueTime": "10:00"
}
],
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/PartialDateTime"
}
]
},
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "58332-8",
"display": "Place of death"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "16983000",
"display": "Death in hospital"
}
]
}
}
]
}
},
{
"fullUrl": "urn:uuid:7a7795a2-8bee-4b96-bd11-c936e0ff11dd",
"resource": {
"resourceType": "Location",
"id": "7a7795a2-8bee-4b96-bd11-c936e0ff11dd",
"meta": {
"profile": [
"http://hl7.org/fhir/us/vrdr/StructureDefinition/vrdr-death-location"
]
},
"name": "BLANK",
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/vrdr/CodeSystem/vrdr-location-type-cs",
"code": "death",
"display": "death location"
}
]
}
],
"address": {
"_district": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/DistrictCode",
"valuePositiveInt": 1
}
]
},
"state": "MA",
"_state": {
"extension": [
{
"url": "http://hl7.org/fhir/us/vrdr/StructureDefinition/Location-Jurisdiction-Id",
"valueString": "MA"
}
]
}
}
}
},
{
"fullUrl": "urn:uuid:5ec296fb-046c-4646-ae8e-5af67f3871b0",
"resource": {
"resourceType": "RelatedPerson",
"id": "5ec296fb-046c-4646-ae8e-5af67f3871b0",
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