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

HL7 PT FHIR Implementation Guide: Noticia de Nascimento, publicado por HL7 Portugal. Este guia não é uma publicação autorizada; é a compilação contínua para a versão 0.0.1 construída pela FHIR (HL7® FHIR® Standard) CI Build. Esta versão é baseada no conteúdo atual de https://github.com/hl7-pt/obs-neonat-ig/tree/master e muda regularmente. Veja o Diretório de versões publicadas

Example Bundle: exemploNN

Document Details

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)

Recursos adicionais incluídos no documento

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

Recurso Procedure:

status: Completed

code: Delivery of vertex presentation (procedure)

subject: NOME DE TESTE (sem género declarado), DoB: 1989-07-30 ( http://example#1234567)

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

Performers

-Actor
*PractitionerRole Obstetrician

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

Recurso Encounter:

status: completed

class: Internamento

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

Recurso Organization:

identifier: 2010491

name: USF ESCARIZ

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

Recurso Patient:

NOME DE TESTE (sem género declarado), DoB: 1989-07-30 ( http://example#1234567)

Detalhes do contactoMORADA DE TESTE
Patient Nationality:
  • code: Portugal

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

Recurso Encounter:

identifier: 18001555

status: completed

class: Internamento

serviceType: Nenhum ecrã para Encounter.serviceType (concept: )

serviceProvider: Organization CH ENTRE DOURO E VOUGA

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

Recurso Organization:

name: CH ENTRE DOURO E VOUGA

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

Recurso Observation:

status: Final

code: Pregnancy (finding)

subject: Doente anónimo Female, DN Desconhecida

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

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

Recurso Patient:

Doente anónimo Female, DN Desconhecida

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

Recurso Observation:

status: Final

category: Vital Signs

code: Weight

subject: Doente anónimo Female, DN Desconhecida

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

value: 3250 gram(s) (Detalhes: UCUM códigog = 'g')

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

Recurso Observation:

status: Final

category: Vital Signs

code: Bdy height

subject: Doente anónimo Female, DN Desconhecida

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

value: 50 cm(s) (Detalhes: UCUM códigocm = 'cm')

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

Recurso Organization:

identifier: http:/example.org/4

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

Recurso Observation:

identifier: http:/example.org/4

status: Final

code: Puerperium observable (observable entity)

value: Normal puerperium (finding)

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

Recurso Immunization:

status: Completed

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

lotNumber: xyz-123

patient: Doente anónimo Female, DN Desconhecida

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

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

Recurso Immunization:

status: Completed

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

lotNumber: abc-9878

patient: Doente anónimo Female, DN Desconhecida

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

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

Recurso Immunization:

status: Completed

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

lotNumber: ghy-123/2024

patient: Doente anónimo Female, DN Desconhecida

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

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

Recurso Observation:

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

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

Recurso Observation:

status: Final

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

value: No abnormality detected - examination result

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

Recurso Observation:

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

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

Recurso Observation:

status: Final

category: Vital Signs

code: Head Circumf OCF

subject: Doente anónimo Female, DN Desconhecida

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

value: 50.1 cm(s) (Detalhes: UCUM códigocm = 'cm')

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

Recurso PractitionerRole:

code: Obstetrician