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-event
Raw xml
<Questionnaire xmlns="http://hl7.org/fhir"> <id value="hai-questionnaire-los-event"/> <meta> <versionId value="3"/> <lastUpdated value="2019-03-13T19:43:37.000-04:00"/> <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 Event (LOS) Report. It records a late onset sepsis/meningitis infection event. <br/>For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present. </p> <h2>Late Onset Sepsis/Meningitis Event (LOS) Instance Details</h2> <table border="1"> <tbody> <tr> <td>url</td> <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event</td> </tr> <tr> <td>Version</td> <td>R1</td> </tr> <tr> <td>title</td> <td>Late Onset Sepsis/Meningitis Event (LOS)</td> </tr> <tr> <td>Publish date</td> <td>2018-09-30</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>Facility ID</td> <td>url</td> <td>true</td> <td>false</td> </tr> <tr> <td/> <td>Event #</td> <td>url</td> <td>false</td> <td>false</td> </tr> <tr> <td/> <td>Event Type</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td/> <td>Date of Event</td> <td>date</td> <td>true</td> <td>false</td> </tr> <tr> <td/> <td>Facility Location</td> <td>choice</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>Inborn/Outborn</td> <td>boolean</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>Central line present prior to event, including umbilical catheter</td> <td>boolean</td> <td>false</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 at Birth</td> <td>quantity</td> <td>true</td> <td>false</td> </tr> <tr> <td/> <td>Event Details</td> <td>group</td> <td>true</td> <td>false</td> </tr> <tr> <td>Event Details</td> <td>Specific Event</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td>Event Details</td> <td>Laboratory Criteria Used</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td>Event Details</td> <td>Died</td> <td>boolean</td> <td>true</td> <td>false</td> </tr> <tr> <td>Event Details</td> <td>Infection contributed to death</td> <td>boolean</td> <td>true if died='true'</td> <td>false</td> </tr> <tr> <td>Event Details</td> <td>Discharge date</td> <td>date</td> <td>false</td> <td>false</td> </tr> <tr> <td/> <td>Findings Group</td> <td>group</td> <td>false</td> <td>true</td> </tr> <tr> <td>Findings Group</td> <td>Pathogen Identified</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td>Findings Group</td> <td>Pathogen Ranking</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td>Findings Group</td> <td>Drug Susceptibility Test Group</td> <td>group</td> <td>false</td> <td>true</td> </tr> <tr> <td>Drug Susceptibility Test Group</td> <td>Drug Susceptibility Test</td> <td>choice</td> <td>true</td> <td>false</td> </tr> <tr> <td>Drug Susceptibility Test Group</td> <td>Drug Susceptibility Test Interpretation</td> <td>choice</td> <td>false</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-event"/> <identifier> <value value="hai-questionnaire-los-event-v1"/> </identifier> <version value="R1"/> <title value="Late Onset Sepsis/Meningitis Event (LOS)"/> <status value="draft"/> <date value="2018-09-30"/> <publisher value="HL7"/> <description value="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."/> <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="facility"/> <text value="Facility ID"/> <type value="url"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="event-number"/> <text value="Event #"/> <type value="url"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="event-type"/> <text value="Event Type"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20"/> </options> </item> <item> <linkId value="date-of-event"/> <text value="Date of Event"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="facility-location"/> <text value="Facility Location"/> <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="date-admitted-to-facility"/> <text value="Date Admitted to Facility:"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="inborn-outborn-observation"/> <code> <system value="http://snomed.info/sct"/> <code value="445087001"/> <display value="Born before arrival to hospital (situation)"/> </code> <text value="Inborn/Outborn: If the infant was outborn (born at a location other than the reporting hospital), select true. If the infant was inborn (born at the reporting hospital) select false."/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </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 central line present, birth weight, gestational age"/> <type value="group"/> <repeats value="false"/> <item> <linkId value="risk-factor-central-line"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1006-6"/> <display value="central line including umbilical catheter"/> </code> <text value="Risk Factor: Central line present prior to event, including umbilical catheter"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <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="event-details"/> <code> <system value="http://loinc.org"/> <code value="51899-3"/> <display value="Details Document"/> </code> <text value="Event Details"/> <type value="group"/> <repeats value="false"/> <item> <linkId value="infection-condition"/> <text value="Specific Event"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196"/> </options> </item> <item> <linkId value="criteria-used"/> <text value="Laboratory Criteria Used"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3195"/> </options> </item> <item> <linkId value="died"/> <code> <system value="http://snomed.info/sct"/> <code value="419099009"/> <display value="dead"/> </code> <text value="Died"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="los-contributed-to-death"/> <text value="Infection contributed to death"/> <type value="boolean"/> <enableWhen> <question value="died"/> <answerBoolean value="true"/> </enableWhen> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="discharge-date"/> <text value="Discharge Date"/> <type value="date"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="findings-group"/> <code> <system value="http://loinc.org"/> <code value="18769-0"/> <display value="Microbial susceptibility tests Set"/> </code> <text value="Findings Group: Records whether infection organisms were identified and, if so, records details about them."/> <type value="group"/> <repeats value="true"/> <item> <linkId value="pathogen-identified"/> <text value="Pathogen Identified"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16"/> </options> </item> <item> <linkId value="pathogen-ranking"/> <text value="Pathogen Ranking"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking"/> </options> </item> <item> <linkId value="drug-susceptibility-test-group"/> <text value="Drug Susceptibility Test Group"/> <type value="group"/> <repeats value="true"/> <item> <linkId value="drug-susceptibility-test"/> <text value="Drug Susceptibility Test"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.15"/> </options> </item> <item> <linkId value="drug-susceptibility-test-interpretation"/> <text value="Drug Susceptibility Test Interpretation"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> <options> <reference value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.13"/> </options> </item> </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>