Frame B is the optional section of the MCCoD document. It captures supplementary medical data about the circumstances of death. While optional at the section level, certain sub-sections carry conditional guidance — expressed as warning-level invariants — based on the clinical context of the death.

Structure Overview

Frame B is divided into three sub-sections within MCCoDComposition, each represented as a nested Composition.section:

Sub-section	Section Code	Cardinality	Conditional Guidance
General Medical Data	mccod-section-codes#frame-b-general	0..1	SHOULD be present when any element is known
Fetal or Infant Death	mccod-section-codes#frame-b-fetal-infant	0..1	SHOULD be populated when deceased was aged less than 28 days or was a stillbirth
Women of Reproductive Age	mccod-section-codes#frame-b-pregnancy	0..1	SHOULD be populated when deceased was female aged 15–49 years

When a Frame B fetal/infant or pregnancy section is present but contains no entries, Composition.section.emptyReason SHALL be populated using a code from http://terminology.hl7.org/CodeSystem/list-empty-reason (e.g. #not-applicable) and a section.text narrative explaining the reason. This is enforced by error-level invariants mccod-comp-empty-reason-fetal and mccod-comp-empty-reason-pregnancy.

Sub-section 1 — General Medical Data

This sub-section contains up to four optional Observation resources covering surgery, autopsy, manner of death, and external cause details.

Surgery Within Last 4 Weeks

Profile: MCCoDSurgeryPerformed

Documents whether surgery was performed within the 4 weeks immediately preceding death. This is clinically relevant as it may contribute to or complicate the cause of death, and is significant for ICD mortality coding of postoperative complications.

Element	FHIR Path	Cardinality	Notes
Was surgery performed?	Observation.valueCodeableConcept	1..1	Required binding: mccod-yes-no-unknown (Yes / No / Unknown)
Date of surgery	Observation.effectiveDateTime	0..1	SHOULD be present when value = Yes
Reason for surgery	Observation.component[reason].valueString	0..1	LOINC 55752-0. SHOULD be present when value = Yes. Free text.

Autopsy

Profile: MCCoDAutopsyPerformed

Documents whether an autopsy was requested and, if so, whether the findings were used in the certification of the cause of death. LOINC 85699-7 (Autopsy was performed) is used as the closest available internationally recognised code; the WHO MCCoD form asks whether autopsy was requested rather than performed — this semantic distinction is documented for national IG authors.

Element	FHIR Path	Cardinality	Notes
Was autopsy requested?	Observation.valueCodeableConcept	1..1	Required binding: mccod-yes-no-unknown
Were findings used in certification?	Observation.component[findingsUsed].valueCodeableConcept	0..1	Required binding: mccod-yes-no-unknown. Applicable only when value = Yes.

Manner of Death

Profile: MCCoDMannerOfDeath

Documents the circumstances under which the cause of death arose. Uses LOINC 69449-7 (Manner of death) as Observation.code. The value is required when this Observation is present and must use a code from the mccod-manner-of-death-codes ValueSet (required binding).

The nine permitted manner of death codes are:

Code	Display	Notes
#disease	Disease	Natural cause, no external factor
#assault	Assault	Intentionally inflicted by another person. External cause section SHOULD be populated.
#accident	Accident	Unintentional injury. External cause section SHOULD be populated.
#legal-intervention	Legal Intervention	Injuries during law enforcement. External cause section SHOULD be populated.
#could-not-be-determined	Could Not Be Determined	Investigation concluded without definitive finding
#pending-investigation	Pending Investigation	Investigation ongoing — provisional status
#intentional-self-harm	Intentional Self Harm	Includes suicide. External cause section SHOULD be populated.
#war	War	Armed conflict. External cause section SHOULD be populated.
#unknown	Unknown	Genuinely not known — use sparingly

When manner of death is one of Assault, Accident, Legal Intervention, Intentional Self Harm, or War, the MCCoDInjuryIncident Observation SHOULD be present — enforced by warning invariant mccod-comp-external-cause-guidance.

External Cause or Poisoning

Profile: MCCoDInjuryIncident

Documents the details of the external cause of death or poisoning. All findings are carried as components; Observation.value[x] is prohibited on this profile.

Element	FHIR Path	Cardinality	Notes
Date of injury	Observation.effectiveDateTime	0..1	Date the external cause occurred
Description of external cause	Observation.component[description].valueString	0..1	Free text. When poisoning: the poisoning agent SHALL be specified here.
Place of occurrence	Observation.component[placeOfOccurrence].valueCodeableConcept	0..1	LOINC 74496-1. Required binding: mccod-place-of-injury-codes. When coded as #other, valueCodeableConcept.text SHALL be populated — enforced by error invariant mccod-injury-place-other-text.

Sub-section 2 — Fetal or Infant Death

Profile: MCCoDFetalOrInfantDeath

This sub-section SHOULD be populated when the deceased was an infant aged less than 28 days at death, or when the death was a stillbirth. This is enforced as a warning-level invariant (mccod-comp-fetal-section-guidance) in MCCoDComposition.

All data elements are captured as Observation.component slices. Seven components are defined:

Component Slice	LOINC / Code	Value Type	WHO MCCoD Form Field
multiplePregnancy	LOINC 57722-1	CodeableConcept (Yes/No/Unknown)	Multiple pregnancy
stillborn	Local #stillborn	CodeableConcept (Yes/No/Unknown)	Stillborn?
hoursSurvived	Local #hours-survived	integer	If death within 24h: number of hours survived
birthWeight	LOINC 8339-4	Quantity (g)	Birth weight in grams
gestationalAge	LOINC 11884-4	Quantity (wk)	Number of completed weeks of pregnancy
motherAge	LOINC 63900-5	Quantity (yr)	Age of mother in years
perinatalMaternalConditions	Local #perinatal-maternal-conditions	string	Conditions of mother affecting fetus/newborn (perinatal deaths)

The hoursSurvived component applies only when stillborn is No and death occurred within 24 hours. A warning invariant (mccod-fetal-hours-conditional) flags this when stillborn is Yes.

Sub-section 3 — Women of Reproductive Age

Profile: MCCoDPregnancyStatus

This sub-section SHOULD be populated when the deceased was female and aged 15–49 years at time of death. This is enforced as a warning-level invariant (mccod-comp-pregnancy-section-guidance) in MCCoDComposition.

The Observation uses LOINC 82810-3 (Pregnancy status) as its code. Three components are defined:

Component Slice	LOINC / Code	Cardinality	Value	WHO MCCoD Form Field
pregnantWithinYear	Local #pregnant-within-year	1..1	CodeableConcept (Yes/No/Unknown)	Was the deceased pregnant within past year?
pregnancyTiming	LOINC 69442-2	0..1	CodeableConcept — mccod-pregnancy-status-codes (required binding)	If yes, was she pregnant: timing options
pregnancyContributedToDeath	Local #pregnancy-contributed-to-death	0..1	CodeableConcept (Yes/No/Unknown)	Did the pregnancy contribute to the death?

The pregnantWithinYear component is 1..1 when this Observation is present — the outer gating question must always be answered. The pregnancyTiming and pregnancyContributedToDeath components are conditional on pregnantWithinYear = Yes, enforced by warning invariants.

The four permitted pregnancy timing codes (ValueSet mccod-pregnancy-status-codes) are:

• #when-died — When she died (pregnant at time of death)
• #within-42-days — Within the 42 days preceding her death
• #43-days-to-1-year — Within 43 days up to 1 year preceding her death
• #timing-unknown — Exact pregnancy timing unknown

These timing categories align with WHO maternal death surveillance definitions and ICD-11 Chapter 18 (Pregnancy, childbirth or the puerperium) coding rules.

Yes / No / Unknown Pattern

All binary questions in Frame B use a consistent Yes/No/Unknown pattern via the mccod-yes-no-unknown ValueSet:

• Yes → http://terminology.hl7.org/CodeSystem/v2-0136#Y
• No → http://terminology.hl7.org/CodeSystem/v2-0136#N
• Unknown → http://terminology.hl7.org/CodeSystem/data-absent-reason#asked-unknown

Invariants Summary

Invariant ID	Severity	Rule	Defined On
mccod-comp-empty-reason-fetal	Error	If fetal/infant section present but empty, emptyReason SHALL be present	MCCoDComposition
mccod-comp-empty-reason-pregnancy	Error	If pregnancy section present but empty, emptyReason SHALL be present	MCCoDComposition
mccod-comp-external-cause-guidance	Warning	If manner is external cause, MCCoDInjuryIncident SHOULD be present	MCCoDComposition
mccod-comp-fetal-section-guidance	Warning	If deceased aged less than 28 days, fetal/infant section SHOULD be populated	MCCoDComposition
mccod-comp-pregnancy-section-guidance	Warning	If deceased female aged 15–49, pregnancy section SHOULD be populated	MCCoDComposition
mccod-manner-value-required	Error	Manner of death value SHALL be present when Observation included	MCCoDMannerOfDeath
mccod-autopsy-value-required	Error	Autopsy value SHALL be present when Observation included	MCCoDAutopsyPerformed
mccod-autopsy-findings-conditional	Warning	findingsUsed SHOULD be absent when autopsy not requested	MCCoDAutopsyPerformed
mccod-surgery-value-required	Error	Surgery value SHALL be present when Observation included	MCCoDSurgeryPerformed
mccod-surgery-date-conditional	Warning	Date of surgery SHOULD be present when surgery was performed	MCCoDSurgeryPerformed
mccod-surgery-reason-conditional	Warning	Reason for surgery SHOULD be present when surgery was performed	MCCoDSurgeryPerformed
mccod-injury-place-other-text	Error	When place = #other, text description SHALL be provided	MCCoDInjuryIncident
mccod-fetal-hours-conditional	Warning	hoursSurvived SHOULD be absent when stillborn = Yes	MCCoDFetalOrInfantDeath
mccod-pregnancy-gating-required	Error	pregnantWithinYear component SHALL be present when Observation included	MCCoDPregnancyStatus
mccod-pregnancy-timing-conditional	Warning	pregnancyTiming SHOULD be present when pregnantWithinYear = Yes	MCCoDPregnancyStatus
mccod-pregnancy-contributed-conditional	Warning	pregnancyContributedToDeath SHOULD be absent when pregnantWithinYear = No	MCCoDPregnancyStatus

Example

See the Examples page for a complete worked example demonstrating Frame B General with manner of death (Disease), autopsy not requested, no surgery within 4 weeks. The fetal/infant and pregnancy sections demonstrate the emptyReason = #not-applicable pattern for an adult male deceased.