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 
Questionnaire: hai-questionnaire-los-event
This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Report. It records a late onset sepsis/meningitis infection event.
For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present.
Late Onset Sepsis/Meningitis Event (LOS) Instance Details
| url | http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event |
| Version | R1 |
| title | Late Onset Sepsis/Meningitis Event (LOS) |
| Publish date | 2018-09-30 |
| Realm | US |
| Code | LOINC 51897-7: Healthcare Associated Infection report Document |
| Subject type | Patient |
Questionnaire Items
| Group | Item | Type | Required | Repeats |
|---|---|---|---|---|
| Facility ID | url | true | false | |
| Event # | url | false | false | |
| Event Type | choice | true | false | |
| Date of Event | date | true | false | |
| Facility Location | choice | true | false | |
| Date Admitted to Facility | date | true | false | |
| Inborn/Outborn | boolean | true | false | |
| Risk Factors | group | true | false | |
| Risk Factors | Central line present prior to event, including umbilical catheter | boolean | false | false |
| Risk Factors | Birth weight (grams) | quantity | true | false |
| Risk Factors | Gestational Age at Birth | quantity | true | false |
| Event Details | group | true | false | |
| Event Details | Specific Event | choice | true | false |
| Event Details | Laboratory Criteria Used | choice | true | false |
| Event Details | Died | boolean | true | false |
| Event Details | Infection contributed to death | boolean | true if died='true' | false |
| Event Details | Discharge date | date | false | false |
| Findings Group | group | false | true | |
| Findings Group | Pathogen Identified | choice | true | false |
| Findings Group | Pathogen Ranking | choice | true | false |
| Findings Group | Drug Susceptibility Test Group | group | false | true |
| Drug Susceptibility Test Group | Drug Susceptibility Test | choice | true | false |
| Drug Susceptibility Test Group | Drug Susceptibility Test Interpretation | choice | false | false |
| Comments | text | false | false |
