NHSN Healthcare Associated Infection (HAI) Reports Long Term Care Facilities
1.1.0 - STU 1.1 United States of America flag

This page is part of the Healthcare Associated Infection Reports (HAI) Long Term Care Facilities (LTCF) (v1.1.0: STU 1.1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: MDRO and CDI Event Report for LTCF - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="hai-ltcf-questionnaireresponse-mdro-cdi-event"/>
  <meta>
    <versionId value="16"/>
    <lastUpdated value="2022-02-11T03:33:12.081+00:00"/>
    <source value="#I9IscIji2Is1qExS"/>
    <profile
             value="http://hl7.org/fhir/us/hai-ltcf/StructureDefinition/hai-ltc-single-person-report-questionnaireresponse"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US">
      <table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;">
        <tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top">
          <th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a>
          </th>
          <th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a>
          </th>
          <th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Definition</a>
          </th>
          <th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a>
            <span style="float: right">
              <a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format">
                <img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/>
              </a>
            </span>
          </th>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> hai-ltcf-questionnaireresponse-mdro-cdi-event </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">QuestionnaireResponse</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> facility-id </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Facility ID</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> date-of-first-admission-to-facility </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of First Admission to Facility</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">2018-12-05</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> date-of-current-admission-to-facility </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of Current Admission to Facility</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">2019-01-15</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> event-details-group </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Event Details Group</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> date-specimen-collected </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date Specimen Collected</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">2019-01-19</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> specimen-type </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Specimen Type</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <span>
              <span>
                <a href="http://snomed.info/id/119339001">SNOMED CT</a> 119339001: Stool specimen (specimen) </span>
            </span>
          </td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> resident-care-location </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Resident Care Location</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:1A</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> primary-resident-service-type </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Primary Resident Service Type</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <span>
              <span>
                <a href="https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/hsloc.html">https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/hsloc.html</a> 1258-3: Long Term Care Facility General Nursing Unit </span>
            </span>
          </td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> encounters-group </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Encounters Group</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> transfer-from-acute-care-facility </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Transfer From Acute Care Facility to LTCF in Past Four Weeks</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> date-of-last-transfer </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of Last Transfer From Acute Care to LTCF</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">2019-01-25</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> antibiotic-at-time-of-transfer </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Resident on Antibiotic Therapy for Specific Organism at Time of Transfer to Facility</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> findings-group </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Findings Group</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> specific-organism-type </td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Specific Organism Type</td>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">
            <span>
              <span>
                <a href="http://snomed.info/id/5933001">SNOMED CT</a> 5933001: Clostridioides difficile (organism) </span>
            </span>
          </td>
        </tr>
        <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy">
            <img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/>
            <img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> nhsn-comment </td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Comments</td>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/>
          <td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">NHSN text comment that is less than 2000 characters.</td>
        </tr>
        <tr>
          <td colspan="4" class="hierarchy">
            <br/>
            <a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format">
              <img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format </a>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <identifier>
    <value value="hai-ltcf-questionnaireresponse-mdro-cdi-event-example-1"/>
  </identifier>
  <questionnaire
                 value="http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-event"/>
  <status value="completed"/>
  <subject>
    <reference value="Patient/hai-ltcf-resident-1"/>
    <display value="hai-ltcf-resident-1"/>
  </subject>
  <author>
    <reference value="Device/hai-ltcf-authoring-device"/>
    <display value="hai-ltcf-authoring-device"/>
  </author>
  <item>
    <linkId value="facility-id"/>
    <text value="Facility ID"/>
    <answer>
      <valueUri value="urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W"/>
    </answer>
  </item>
  <item>
    <linkId value="date-of-first-admission-to-facility"/>
    <text value="Date of First Admission to Facility"/>
    <answer>
      <valueDate value="2018-12-05"/>
    </answer>
  </item>
  <item>
    <linkId value="date-of-current-admission-to-facility"/>
    <text value="Date of Current Admission to Facility"/>
    <answer>
      <valueDate value="2019-01-15"/>
    </answer>
  </item>
  <item>
    <linkId value="event-details-group"/>
    <text value="Event Details Group"/>
    <item>
      <linkId value="date-specimen-collected"/>
      <text value="Date Specimen Collected"/>
      <answer>
        <valueDate value="2019-01-19"/>
      </answer>
    </item>
    <item>
      <linkId value="specimen-type"/>
      <text value="Specimen Type"/>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="119339001"/>
          <display value="Stool specimen (specimen)"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="resident-care-location"/>
      <text value="Resident Care Location"/>
      <answer>
        <valueUri value="urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:1A"/>
      </answer>
    </item>
    <item>
      <linkId value="primary-resident-service-type"/>
      <text value="Primary Resident Service Type"/>
      <answer>
        <valueCoding>
          <system
                  value="https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/hsloc.html"/>
          <code value="1258-3"/>
          <display value="Long Term Care Facility General Nursing Unit"/>
        </valueCoding>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="encounters-group"/>
    <text value="Encounters Group"/>
    <item>
      <linkId value="transfer-from-acute-care-facility"/>
      <text
            value="Transfer From Acute Care Facility to LTCF in Past Four Weeks"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
    <item>
      <linkId value="date-of-last-transfer"/>
      <text value="Date of Last Transfer From Acute Care to LTCF"/>
      <answer>
        <valueDate value="2019-01-25"/>
      </answer>
    </item>
    <item>
      <linkId value="antibiotic-at-time-of-transfer"/>
      <text
            value="Resident on Antibiotic Therapy for Specific Organism at Time of Transfer to Facility"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="findings-group"/>
    <text value="Findings Group"/>
    <item>
      <linkId value="specific-organism-type"/>
      <text value="Specific Organism Type"/>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="5933001"/>
          <display value="Clostridioides difficile (organism)"/>
        </valueCoding>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="nhsn-comment"/>
    <text value="Comments"/>
    <answer>
      <valueString
                   value="NHSN text comment that is less than 2000 characters."/>
    </answer>
  </item>
</QuestionnaireResponse>