# MII PR Person Vitalstatus - MII Implementation Guide Core Dataset Base v2026.0.0

## Resource Profile: MII PR Person Vitalstatus 

 
Vital status of a patient. 

**Example Usage Scenarios:**

* Document the vital status (alive/deceased) of a patient at specific points in time
* Track the last known alive timepoint for patients in clinical and research contexts
* Record vital status observations at each hospital admission and discharge
* Support mortality analyses and survival studies in research use cases
* Maintain vital status history through multiple observation instances over time

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the MII Vital Status Profile.

#### Observation Instance Requirements

**Multiple Observations:**

* A **new** Observation instance **MUST** be created for each observation/documentation of a patient's vital status
* All Observation instances **MUST** have `status='final'`
* Each instance represents a point-in-time assertion about the patient's vital status

**Frequency of Documentation:**

* Vital status ("last known alive timepoint") **SHOULD** be documented as an event-based Observation at least at each admission/discharge
* Frequency of vital status assessment is otherwise not strictly regulated and may vary
* Source data is often difficult to obtain and may require manual research (e.g., contact attempts, public information such as death notices)

##### Best Practice - Vital Status Data Sources

**Administrative Discharge:** Administrative discharge of a patient due to death **SHOULD** be documented (see Fall module - Entlassungsgrund/discharge disposition) and **CAN** serve as a useful data source for vital status.

**Integration:** Systems should establish workflows to automatically create vital status observations when discharge disposition indicates death, ensuring consistency between administrative and clinical documentation.

**Manual Research:** In cases where vital status is unclear, manual research may be necessary (contact attempts, public records). Document the information source appropriately in associated metadata (Provenance resource).

#### Required Elements

**Fixed Values:**

* **`Observation.category`**: Fixed value `survey` **MUST** be present; additional codings are OPTIONAL
* **`Observation.code`**: Fixed LOINC code `67162-8` (Vitalstatus [Minimum Data Set]) **MUST** be present; additional codings are OPTIONAL

**Patient Reference:**

* **`Observation.subject`**: Reference to Patient **MUST** always be provided
* Vital status is inherently patient-specific and cannot exist without this reference

**Effective DateTime:**

* **`Observation.effectiveDateTime`**: [Mandatory](general-requirements.md) precise specification of the last known alive timepoint 
* **MAY** contain partial date specifications (year, year-month) when exact date is unknown
* **Does NOT** represent the time of death (see `Patient.deceased[x]` for death documentation)
* Represents the point in time when the patient was known to be in the documented vital status
 

##### Best Practice - effectiveDateTime vs. Patient.deceased[x]

**Distinction:** `Observation.effectiveDateTime` represents the **last known alive timepoint** or the time when vital status was assessed, NOT the time of death.

**Death Documentation:** Use `Patient.deceased[x]` (preferably `deceasedDateTime`) to document the actual time of death.

**Example Scenario:**

* Patient discharged alive on 2024-03-15 → Vital status Observation with `effectiveDateTime = 2024-03-15` and `valueCodeableConcept = "L" (lebend/alive)`
* Patient confirmed deceased on 2024-04-20 → Update `Patient.deceasedDateTime = 2024-04-20` and create new Vital status Observation with `effectiveDateTime = 2024-04-20` and `valueCodeableConcept = "T" (tot/deceased)`

#### Value Documentation

**`Observation.valueCodeableConcept`:**

* Uses codes from the MII Vitalstatus CodeSystem: 
* `L` = lebend (alive)
* `T` = tot (deceased)
* `X` = unbekannt (unknown)
 

See [Formal Views](#profile) for the complete ValueSet binding.

**Usages:**

* Examples for this Profile: [Observation/mii-exa-person-observation-vitalstatus-discharge](Observation-mii-exa-person-observation-vitalstatus-discharge.md) and [Observation/mii-exa-person-observation-vitalstatus](Observation-mii-exa-person-observation-vitalstatus.md)
* CapabilityStatements using this Profile: [MII CPS Person CapabilityStatement](CapabilityStatement-mii-cps-person-capabilitystatement.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/de.medizininformatikinitiative.kerndatensatz.base|current/StructureDefinition/mii-pr-person-vitalstatus)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](../StructureDefinition-mii-pr-person-vitalstatus.csv), [Excel](../StructureDefinition-mii-pr-person-vitalstatus.xlsx), [Schematron](../StructureDefinition-mii-pr-person-vitalstatus.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "mii-pr-person-vitalstatus",
  "extension" : [
    {
      "url" : "https://www.medizininformatik-initiative.de/fhir/modul-meta/StructureDefinition/mii-ex-meta-license-codeable",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/spdx-license",
            "code" : "CC-BY-4.0",
            "display" : "Creative Commons Attribution 4.0 International"
          }
        ]
      }
    }
  ],
  "url" : "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Vitalstatus",
  "version" : "2026.0.0",
  "name" : "MII_PR_Person_Vitalstatus",
  "title" : "MII PR Person Vitalstatus",
  "_title" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de-DE"
          },
          {
            "url" : "content",
            "valueString" : "Vitalstatus"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      },
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "en-US"
          },
          {
            "url" : "content",
            "valueString" : "Vital status"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "status" : "active",
  "date" : "2025-12-12",
  "publisher" : "Medical Informatics Initiative (MII)",
  "_publisher" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de"
          },
          {
            "url" : "content",
            "valueString" : "Medizininformatik-Initiative (MII)"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "contact" : [
    {
      "name" : "Medical Informatics Initiative (MII)",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.medizininformatik-initiative.de/en"
        }
      ]
    }
  ],
  "description" : "Dieses Profil beschreibt den Vitalstatus der Patient*in in der Medizininformatik-Initiative.",
  "_description" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de-DE"
          },
          {
            "url" : "content",
            "valueString" : "Vitalstatus einer Patientin oder eines Patienten."
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      },
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "en-US"
          },
          {
            "url" : "content",
            "valueString" : "Vital status of a patient."
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "DE",
          "display" : "Germany"
        }
      ]
    }
  ],
  "fhirVersion" : "4.0.1",
  "mapping" : [
    {
      "identity" : "workflow",
      "uri" : "http://hl7.org/fhir/workflow",
      "name" : "Workflow Pattern"
    },
    {
      "identity" : "sct-concept",
      "uri" : "http://snomed.info/conceptdomain",
      "name" : "SNOMED CT Concept Domain Binding"
    },
    {
      "identity" : "v2",
      "uri" : "http://hl7.org/v2",
      "name" : "HL7 v2 Mapping"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM Mapping"
    },
    {
      "identity" : "w5",
      "uri" : "http://hl7.org/fhir/fivews",
      "name" : "FiveWs Pattern Mapping"
    },
    {
      "identity" : "sct-attr",
      "uri" : "http://snomed.org/attributebinding",
      "name" : "SNOMED CT Attribute Binding"
    }
  ],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [
      {
        "id" : "Observation",
        "path" : "Observation"
      },
      {
        "id" : "Observation.id",
        "path" : "Observation.id",
        "mustSupport" : true
      },
      {
        "id" : "Observation.meta",
        "path" : "Observation.meta",
        "mustSupport" : true
      },
      {
        "id" : "Observation.meta.profile",
        "path" : "Observation.meta.profile",
        "mustSupport" : true
      },
      {
        "id" : "Observation.status",
        "path" : "Observation.status",
        "short" : "Status",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Status"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Status"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "abgeschlossen",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "abgeschlossen"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "completed"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "fixedCode" : "final",
        "mustSupport" : true
      },
      {
        "id" : "Observation.category",
        "path" : "Observation.category",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "short" : "Kategorie",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kategorie"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Category"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Klassifikation des Typs der Beobachtung für den Vitalstatus.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Klassifikation des Typs der Beobachtung für den Vitalstatus."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Classification of type of observation for vital status."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.category:survey",
        "path" : "Observation.category",
        "sliceName" : "survey",
        "min" : 1,
        "max" : "1",
        "patternCodeableConcept" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
              "code" : "survey"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code",
        "path" : "Observation.code",
        "short" : "Code",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Code"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Code"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Ein LOINC Code, der die Vitalstatus Beobachtung identifiziert.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Ein LOINC Code, der die Vitalstatus Beobachtung identifiziert."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "A LOINC code identifying the vital status observation."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding",
        "path" : "Observation.code.coding",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc",
        "path" : "Observation.code.coding",
        "sliceName" : "loinc",
        "short" : "LOINC Code",
        "definition" : "LOINC Code für Vitalstatus",
        "min" : 1,
        "max" : "1",
        "patternCoding" : {
          "system" : "http://loinc.org",
          "code" : "67162-8"
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc.system",
        "path" : "Observation.code.coding.system",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc.code",
        "path" : "Observation.code.coding.code",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.subject",
        "path" : "Observation.subject",
        "min" : 1,
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Group"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.encounter",
        "path" : "Observation.encounter",
        "short" : "Kontakt (Aufenthaltsbezug)",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kontakt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Encounter"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Kontakt, bei dem der Vitalstatus festgestellt wurde.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kontakt, bei dem der Vitalstatus festgestellt wurde."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Encounter during which the vital status was determined."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.effective[x]",
        "path" : "Observation.effective[x]",
        "short" : "Zeitpunkt",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Zeitpunkt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Point in time"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Der Zeitpunkt, zu dem der beobachtete Vitalstatus als wahr festgestellt wird.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Der Zeitpunkt, zu dem der beobachtete Vitalstatus als wahr festgestellt wird."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "The time the observed vital status is asserted as being true."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "type" : [
          {
            "code" : "dateTime"
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x]",
        "path" : "Observation.value[x]",
        "short" : "Codierter Wert",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Wert"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Value"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Der codierte Wert für den Vitalstatus.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "lebendig | verstorben | unbekannt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "alive | deceased | unknown"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding",
        "path" : "Observation.value[x].coding",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus",
        "path" : "Observation.value[x].coding",
        "sliceName" : "Vitalstatus",
        "short" : "Vitalstatus",
        "definition" : "Der Vitalstatus der Person.",
        "min" : 1,
        "max" : "1",
        "mustSupport" : true,
        "binding" : {
          "strength" : "required",
          "valueSet" : "https://www.medizininformatik-initiative.de/fhir/core/modul-person/ValueSet/Vitalstatus"
        }
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus.system",
        "path" : "Observation.value[x].coding.system",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus.code",
        "path" : "Observation.value[x].coding.code",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.note",
        "path" : "Observation.note",
        "short" : "Hinweis",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Hinweis"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Note"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Zusätzliche Informationen zum Vitalstatus als Freitext.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Zusätzliche Informationen zum Vitalstatus als Freitext."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Additional information about the vital status as free text."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.bodySite",
        "path" : "Observation.bodySite",
        "max" : "0"
      },
      {
        "id" : "Observation.specimen",
        "path" : "Observation.specimen",
        "max" : "0"
      },
      {
        "id" : "Observation.referenceRange",
        "path" : "Observation.referenceRange",
        "max" : "0"
      },
      {
        "id" : "Observation.component",
        "path" : "Observation.component",
        "max" : "0"
      }
    ]
  }
}

```
