Healthcare Associated Infection Reports, FHIR STU 2 Ballot - US Realm Implementation Guide CI Build

This page is part of the Healthcare Associated Infection Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R3. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

XML Format: Questionnaire-hai-questionnaire-los-denom

Raw xml 


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="hai-questionnaire-los-denom"/>
  <meta>
    <versionId value="5"/>
    <lastUpdated value="2019-03-13T21:32:00.000-04:00"/>
    <profile
             value="http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" lang="en-US">
      <p>This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Denominator. This report records the denominator information for neonatal component late onset sepsis and meningitis (LOS/Men).</p>
      <h2>Late Onset Sepsis/Meningitis Denominator</h2>
      <table border="1">
        <tbody>
          <tr>
            <td>url</td>
            <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom</td>
          </tr>
          <tr>
            <td>Version</td>
            <td>R1</td>
          </tr>
          <tr>
            <td>title</td>
            <td>Late Onset Sepsis/Meningitis Denominator</td>
          </tr>
          <tr>
            <td>Publish date</td>
            <td>2019-04-01</td>
          </tr>
          <tr>
            <td>Realm</td>
            <td>US</td>
          </tr>
          <tr>
            <td>Code</td>
            <td>LOINC 51897-7: Healthcare Associated Infection report Document</td>
          </tr>
          <tr>
            <td>Subject type</td>
            <td>Patient</td>
          </tr>
        </tbody>
      </table>
      <h2>Questionnaire Items</h2>
      <table border="1">
        <thead>
          <tr>
            <th>Group</th>
            <th>Item</th>
            <th>Type</th>
            <th>Required</th>
            <th>Repeats</th>
          </tr>
        </thead>
        <tbody>
          <tr>
            <td/>
            <td>Year and month data collected for this location</td>
            <td>date</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Facility ID</td>
            <td>url</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Date Admitted to Facility</td>
            <td>date</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Location Within Facility Encounter</td>
            <td>group</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Location Within Facility Encounter</td>
            <td>Facility Location Type</td>
            <td>choice</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Location Within Facility Encounter</td>
            <td>Facility Location</td>
            <td>url</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Location Within Facility Encounter</td>
            <td>Date admitted or transferred to location</td>
            <td>date</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Location Within Facility Encounter</td>
            <td>Disposition of infant</td>
            <td>choice</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Location Within Facility Encounter</td>
            <td>Disposition date if discharged, transferred, or expired</td>
            <td>date</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Risk Factors</td>
            <td>group</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Risk Factors</td>
            <td>Birth weight (grams)</td>
            <td>quantity</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Risk Factors</td>
            <td>Gestational age (days)</td>
            <td>quantity</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Comments</td>
            <td>text</td>
            <td>false</td>
            <td>false</td>
          </tr>
        </tbody>
      </table>
    </div>
  </text>
  <url
       value="http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom"/>
  <identifier>
    <value value="hai-questionnaire-los-denom-v1"/>
  </identifier>
  <version value="R1"/>
  <name value="hai-questionnaire-los-denom"/>
  <title value="Late Onset Sepsis/Meningitis Denominator"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2019-04-01"/>
  <publisher value="HL7"/>
  <description
               value="This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Denominator. This report records the denominator information for neonatal component late onset sepsis and meningitis (LOS/Men)."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <code>
    <system value="http://loinc.org"/>
    <code value="51897-7"/>
    <display value="Healthcare Associated Infection report Document"/>
  </code>
  <subjectType value="Patient"/>
  <item>
    <linkId value="date-collected"/>
    <text value="Year and month data collected for this location"/>
    <type value="date"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="facility"/>
    <text value="Facility ID"/>
    <type value="url"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="date-admitted-to-facility"/>
    <text value="Date Admitted to Facility"/>
    <type value="date"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="location-within-facility-encounter-group"/>
    <code>
      <system value="http://loinc.org"/>
      <code value="46240-8"/>
      <display value="History of Hospitalizations+Outpatient visits Narrative"/>
    </code>
    <text value="Location Within Facility Encounter"/>
    <type value="group"/>
    <repeats value="false"/>
    <item>
      <linkId value="facility-location-type"/>
      <text value="Facility Location Type"/>
      <type value="choice"/>
      <required value="true"/>
      <repeats value="false"/>
      <options>
        <reference
                   value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.19"/>
      </options>
    </item>
    <item>
      <linkId value="facility-location"/>
      <text value="Facility Location"/>
      <type value="url"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="location-admit-transfer-date"/>
      <text value="Date admitted or transferred to location"/>
      <type value="date"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="infant-disposition"/>
      <text value="Disposition of infant"/>
      <type value="choice"/>
      <required value="true"/>
      <repeats value="false"/>
      <options>
        <reference
                   value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.30"/>
      </options>
    </item>
    <item>
      <linkId value="disposition-date"/>
      <text value="Disposition date if discharged, transferred, or expired"/>
      <type value="date"/>
      <enableWhen>
        <question value="infant-disposition"/>
        <answerCoding>
          <system value="http://snomed.info/sct"/>
          <code value="183665006"/>
        </answerCoding>
      </enableWhen>
      <enableWhen>
        <question value="infant-disposition"/>
        <answerCoding>
          <system value="http://snomed.info/sct"/>
          <code value="266751003"/>
        </answerCoding>
      </enableWhen>
      <enableWhen>
        <question value="infant-disposition"/>
        <answerCoding>
          <system value="http://snomed.info/sct"/>
          <code value="371828006"/>
        </answerCoding>
      </enableWhen>
      <required value="false"/>
      <repeats value="false"/>
    </item>
  </item>
  <item>
    <linkId value="risk-factors"/>
    <code>
      <system value="http://loinc.org"/>
      <code value="51898-5"/>
      <display value="Risk factors Document"/>
    </code>
    <text value="Risk Factors: Contains birth weight and gestational age"/>
    <type value="group"/>
    <repeats value="false"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit">
        <valueCoding>
          <system value="http://unitsofmeasure.org"/>
          <code value="g"/>
          <display value="g"/>
        </valueCoding>
      </extension>
      <linkId value="risk-factor-birth-weight"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="364589006"/>
        <display value="Birth Weight"/>
      </code>
      <text value="Risk Factor: Birth weight (grams)"/>
      <type value="quantity"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit">
        <valueCoding>
          <system value="http://unitsofmeasure.org"/>
          <code value="d"/>
          <display value="d"/>
        </valueCoding>
      </extension>
      <linkId value="risk-factor-gestational-age"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="76516-4"/>
        <display value="Gestational age--at birth"/>
      </code>
      <text value="Risk Factor: Gestational age (days)"/>
      <type value="quantity"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
  </item>
  <item>
    <linkId value="nhsn-comment"/>
    <code>
      <system value="http://www.loinc.org"/>
      <code value="86468-6"/>
      <display value="Report Comment Section"/>
    </code>
    <text value="Comments"/>
    <type value="text"/>
    <required value="false"/>
    <repeats value="false"/>
    <maxLength value="2000"/>
  </item>
</Questionnaire>