This page is part of the Healthcare Associated Infection Reports (HAI) Long Term Care Facilities (LTCF) (v0.1.0: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
JSON Format: Questionnaire-hai-ltcf-questionnaire-mdro-cdi-summary
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-ltcf-questionnaire-mdro-cdi-summary",
"meta" : {
"versionId" : "2",
"lastUpdated" : "2019-07-05T01:19:42.000-04:00"
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <h1 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF</h1>\n <p xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <p>This Questionnaire instance defines the questions and possible answers in the MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF. It records the monthly aggregate data for Multi-Drug Resistant Organisms (MDRO) and Clostridium difficile (C. diff, CDI).</p>\n \n <p>For further details see the NHSN website <a href=\"https://www.cdc.gov/nhsn/\">https://www.cdc.gov/nhsn/</a> for reporting healthcare-associated infections in long-term care facilities. The concepts reported in this document-type are defined for the NHSN "<i>LabID Event Protocol for LTCF</i>" and the corresponding data collection form "<i>57.139 MDRO and CDI Monthly Monitoring for LTCF</i>".</p>\n </p>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Details</h2>\n <table xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <tr>\n <td>\n <b>Id:</b>\n </td>\n <td>hai-ltcf-questionnaire-mdro-cdi-summary</td>\n </tr>\n <tr>\n <td>\n <b>Meta:</b>\n </td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>2</li>\n <li>2019-07-05T01:19:42.000-04:00</li>\n <li>http://hl7.org/fhir/us/hai/StructureDefinition/hai-population-summary-questionnaire</li>\n </ul>\n </td>\n </tr>\n <tr>\n <td>\n <b>Language:</b>\n </td>\n <td>en-US</td>\n </tr>\n <tr>\n <td>\n <b>Url:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary</td>\n </tr>\n <tr>\n <td>\n <b>Identifier:</b>\n </td>\n <td>\n <span>hai-questionnaire-opc-sdom-summary-v1</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Version:</b>\n </td>\n <td>Version: 1.0.0</td>\n </tr>\n <tr>\n <td>\n <b>Name:</b>\n </td>\n <td>HAI-LTCF-questionnaire-mdro-cdi-summary</td>\n </tr>\n <tr>\n <td>\n <b>Status:</b>\n </td>\n <td>draft</td>\n </tr>\n <tr>\n <td>\n <b>Experimental:</b>\n </td>\n <td>false</td>\n </tr>\n <tr>\n <td>\n <b>Subject Type:</b>\n </td>\n <td>Group</td>\n </tr>\n <tr>\n <td>\n <b>Date:</b>\n </td>\n <td>2019-08-01</td>\n </tr>\n <tr>\n <td>\n <b>Publisher:</b>\n </td>\n <td>HL7</td>\n </tr>\n <tr>\n <td>\n <b>Jurisdiction:</b>\n </td>\n <td>\n <span title=\"Code system: urn:iso:std:iso:3166\">Code: US</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Code:</b>\n </td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>Summary data reporting outpatient procedure component events at a facility</li>\n <li>Code system: <a href=\"CodeSystem-2.16.840.1.113883.6.277.html\">http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277</a>\n </li>\n <li>Code: 1657-6</li>\n </ul>\n </td>\n </tr>\n </table>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Items</h2>\n <table border=\"1\" xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <tr>\n <th align=\"left\">Group</th>\n <th align=\"left\">text</th>\n <th align=\"left\">linkId</th>\n <th align=\"left\">type</th>\n <th align=\"left\">required</th>\n <th align=\"left\">repeats</th>\n <th align=\"left\">enableWhen</th>\n <th align=\"left\">answerValueSet</th>\n </tr>\n <tr>\n <td/>\n <td>Facility ID</td>\n <td>facility-id</td>\n <td>url</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td/>\n <td>First Day of Period Reported</td>\n <td>report-period-start</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td/>\n <td>Last Day of Period Reported</td>\n <td>report-period-end</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td/>\n <td>Facility Location Code</td>\n <td>facility-location-code</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td>\n <a href=\"ValueSet-2.16.840.1.113883.13.19.html\">http://hl7.org/fhir/us/hai-ltcf/ValueSet/2.16.840.1.113883.13.19</a>\n </td>\n </tr>\n <tr>\n <td colspan=\"8\">The Summary Data Group a set of summary data for a population in the defined NHSN protocol.</td>\n </tr>\n <tr>\n <td/>\n <td>Summary Data Group</td>\n <td>summary-data-group</td>\n <td>group</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n <tr>\n <td>Summary Data Group</td>\n <td>Resident Days</td>\n <td>resident-days</td>\n <td>integer</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Summary Data Group</td>\n <td>Resident Admissions</td>\n <td>resident-admissions</td>\n <td>integer</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Summary Data Group</td>\n <td>Number of Admissions on C. diff Treatment</td>\n <td>number-admissions-on-c-diff-treatment</td>\n <td>integer</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Summary Data Group</td>\n <td>Number of C. diff Treatment Starts</td>\n <td>number-c-diff-treatment-starts</td>\n <td>integer</td>\n <td>true</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n </tr>\n <tr>\n <td colspan=\"8\">The Report No Events Group contains statements that there are no events to report for a particular type of event.</td>\n </tr>\n <tr>\n <td/>\n <td>Report no events</td>\n <td>report-no-events-group</td>\n <td>group</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus</td>\n <td>no-lab-id-event-mrsa</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus</td>\n <td>no-lab-id-event-mssa</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - Vancomycin resistant Enterococcus</td>\n <td>no-lab-id-event-vre</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - CephR Klebsiella</td>\n <td>no-lab-id-event-cephr-klebsiella</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - CRE E. coli</td>\n <td>no-lab-id-event-mrsa-cre-e-coli</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - CRE Enterobacter</td>\n <td>no-lab-id-event-mrsa-cre-enterobacter</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - CRE Klebsiella</td>\n <td>no-lab-id-event-cre-klebsiella</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - Acinetobacter</td>\n <td>no-lab-id-event-mdr-acinetobacter</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n <tr>\n <td>Report no events</td>\n <td>Report no labID event - All specimens - Clostridium difficile</td>\n <td>no-lab-id-event-c-difficile</td>\n <td>boolean</td>\n <td>false</td>\n <td>false</td>\n <td/>\n <td/>\n </tr>\n </tr>\n </table>\n </div>"
},
"url" : "http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary",
"identifier" : [
{
"value" : "hai-ltcf-questionnaire-mdro-cdi-summary-v1"
}
],
"version" : "1.0.0",
"name" : "HAI_LTCF_questionnaire_mdro_cdi_summary",
"title" : "MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF",
"status" : "draft",
"experimental" : false,
"subjectType" : [
"Group"
],
"date" : "2019-08-01",
"publisher" : "HL7",
"description" : "This Questionnaire instance defines the questions and possible answers in the MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF. It records the monthly aggregate data for Multi-Drug Resistant Organisms (MDRO) and Clostridium difficile (C. diff, CDI).",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1657-6",
"display" : "Summary data reporting outpatient procedure component events at a facility"
}
],
"item" : [
{
"linkId" : "facility-id",
"text" : "Facility ID",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "report-period-start",
"text" : "First Day of Period Reported",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "report-period-end",
"text" : "Last Day of Period Reported",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "facility-location-code",
"text" : "Facility Location Code",
"type" : "choice",
"required" : true,
"repeats" : false,
"answerValueSet" : "http://hl7.org/fhir/us/hai-ltcf/ValueSet/2.16.840.1.113883.13.19"
},
{
"linkId" : "summary-data-group",
"code" : [
{
"system" : "http://loinc.org",
"code" : "51900-9",
"display" : "Population Summary note"
}
],
"text" : "Summary Data Group",
"type" : "group",
"required" : true,
"repeats" : false,
"item" : [
{
"linkId" : "summary-data-group-display",
"text" : "The Summary Data Group a set of summary data for a population in the defined NHSN protocol.",
"type" : "display"
},
{
"linkId" : "resident-days",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1369-8",
"display" : "Resident days"
}
],
"text" : "Resident Days",
"type" : "integer",
"required" : true,
"repeats" : false
},
{
"linkId" : "resident-admissions",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1370-6",
"display" : "Resident admissions"
}
],
"text" : "Resident Admissions",
"type" : "integer",
"required" : true,
"repeats" : false
},
{
"linkId" : "number-admissions-on-c-diff-treatment",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1371-4",
"display" : "Number of admissions on C. diff treatment"
}
],
"text" : "Number of Admissions on C. diff Treatment",
"type" : "integer",
"required" : true,
"repeats" : false
},
{
"linkId" : "number-c-diff-treatment-starts",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1372-2",
"display" : "Number of residents started on antibiotic treatment for C. diff"
}
],
"text" : "Number of C. diff Treatment Starts",
"type" : "integer",
"required" : true,
"repeats" : false
}
]
},
{
"linkId" : "report-no-events-group",
"code" : [
{
"system" : "http://loinc.org",
"code" : "90252-8",
"display" : "Report no events"
}
],
"text" : "Report no events",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [
{
"linkId" : "report-no-events-group-display",
"text" : "The Report No Events Group contains statements that there are no events to report for a particular type of event.",
"type" : "display"
},
{
"linkId" : "no-lab-id-event-mrsa",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3030-4",
"display" : "Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus"
}
],
"text" : "Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-mssa",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1307-8",
"display" : "Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus"
}
],
"text" : "Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-vre",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3033-8",
"display" : "Report no labID event - All specimens - Vancomycin resistant Enterococcus"
}
],
"text" : "Report no labID event - All specimens - Vancomycin resistant Enterococcus",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-cephr-klebsiella",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3036-1",
"display" : "Report no labID event - All specimens - CephR Klebsiella"
}
],
"text" : "Report no labID event - All specimens - CephR Klebsiella",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-mrsa-cre-e-coli",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3039-5",
"display" : "Report no labID event - All specimens - CRE E. coli"
}
],
"text" : "Report no labID event - All specimens - CRE E. coli",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-mrsa-cre-enterobacter",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3042-9",
"display" : "Report no labID event - All specimens - CRE Enterobacter"
}
],
"text" : "Report no labID event - All specimens - CRE Enterobacter",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-cre-klebsiella",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3045-2",
"display" : "Report no labID event - All specimens - CRE Klebsiella"
}
],
"text" : "Report no labID event - All specimens - CRE Klebsiella",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-mdr-acinetobacter",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3048-6",
"display" : "Report no labID event - All specimens - Acinetobacter"
}
],
"text" : "Report no labID event - All specimens - Acinetobacter",
"type" : "boolean",
"required" : false,
"repeats" : false
},
{
"linkId" : "no-lab-id-event-c-difficile",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3051-0",
"display" : "Report no labID event - All specimens - Clostridium difficile"
}
],
"text" : "Report no labID event - All specimens - Clostridium difficile",
"type" : "boolean",
"required" : false,
"repeats" : false
}
]
}
]
}
