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 
JSON Format: Questionnaire-hai-questionnaire-opc-proc-denom
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-questionnaire-opc-proc-denom",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-13T23:50:43.000-04:00",
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <p>This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Denominator for Procedure. This report records the denominator information for outpatient procedures.</p>\n <h2>Outpatient Procedure Component Denominator for Procedure</h2>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>url</td>\n <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom</td>\n </tr>\n <tr>\n <td>Version</td>\n <td>R1</td>\n </tr>\n <tr>\n <td>title</td>\n <td>Outpatient Procedure Component Denominator for Procedure</td>\n </tr>\n <tr>\n <td>Publish date</td>\n <td>2019-04-01</td>\n </tr>\n <tr>\n <td>Realm</td>\n <td>US</td>\n </tr>\n <tr>\n <td>Code</td>\n <td>LOINC 51897-7: Healthcare Associated Infection report Document</td>\n </tr>\n <tr>\n <td>Subject type</td>\n <td>Patient</td>\n </tr>\n </tbody>\n </table>\n <h2>Questionnaire Items</h2>\n <table border=\"1\">\n <thead>\n <tr>\n <th>Group</th>\n <th>Item</th>\n <th>Type</th>\n <th>Required</th>\n <th>Repeats</th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td/>\n <td>Facility ID</td>\n <td>url</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Event #</td>\n <td>url</td>\n <td>false</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Event Type</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Encounter date</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Risk Factors</td>\n <td>group</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>Wound Class</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>Endoscopy</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>Diabetes mellitus</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>Height</td>\n <td>quantity</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>Weight</td>\n <td>quantity</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Risk Factors</td>\n <td>ASA Class</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Procedure Details</td>\n <td>g</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>NHSN Procedure Code Category</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>CPT Procedure Code</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>CPT Procedure Code</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>Procedure Duration</td>\n <td>time</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>General anesthesia</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Procedure Details</td>\n <td>Surgeon code</td>\n <td>url</td>\n <td>true</td>\n <td>false</td>\n </tr>\n </tbody>\n </table>\n </div>"
},
"url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom",
"identifier" : [
{
"value" : "hai-questionnaire-opc-proc-denom-v1"
}
],
"version" : "R1",
"name" : "hai-questionnaire-opc-proc-denom",
"title" : "Outpatient Procedure Component Denominator for Procedure",
"status" : "draft",
"experimental" : false,
"date" : "2019-04-01",
"publisher" : "HL7",
"description" : "This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Denominator for Procedure. This report records datea on each patient having one of the NHSN procedures selected for monitoring.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"code" : [
{
"system" : "http://loinc.org",
"code" : "51897-7",
"display" : "Healthcare Associated Infection report Document"
}
],
"subjectType" : [
"Patient"
],
"item" : [
{
"linkId" : "facility-id",
"text" : "Facility ID",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "event-number",
"text" : "Event Number",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "encounter-date",
"text" : "Date of encounter",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "risk-factors",
"code" : [
{
"system" : "http://loinc.org",
"code" : "51898-5",
"display" : "Risk factors Document"
}
],
"text" : "Risk Factors",
"type" : "group",
"repeats" : false,
"item" : [
{
"linkId" : "risk-factor-wound-class",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "420089007",
"display" : "CDC wound classification category"
}
],
"text" : "Risk Factor: Wound class",
"type" : "choice",
"required" : false,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.9"
}
},
{
"linkId" : "risk-factor-endoscopy",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "423827005",
"display" : "Endoscopy"
}
],
"text" : "Risk Factor: Endoscopy used",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "risk-factor-diabetes-mellitus",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "73211009",
"display" : "Diabetes mellitus"
}
],
"text" : "Risk Factor: Diabetes mellitus",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "risk-factor-height",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "50373000",
"display" : "Body Height"
}
],
"text" : "Risk Factor: height",
"type" : "quantity",
"required" : true,
"repeats" : false
},
{
"linkId" : "risk-factor-weight",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "27113001",
"display" : "Body Weight"
}
],
"text" : "Risk Factor: height",
"type" : "quantity",
"required" : true,
"repeats" : false
},
{
"linkId" : "risk-factor-asa-class",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "273270000",
"display" : "American Society of Anesthesiologists physical status classification (assessment scale)"
}
],
"text" : "Risk Factor: ASA Class",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.10"
}
}
]
},
{
"linkId" : "procedure-details",
"code" : [
{
"system" : "http://loinc.org",
"code" : "51899-3",
"display" : "Details Document"
}
],
"text" : "Procedure Details",
"type" : "group",
"repeats" : false,
"item" : [
{
"linkId" : "nhsn-procedure-code-category",
"text" : "NHSN Procedure Code Category",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34"
}
},
{
"linkId" : "cpt-procedure-code",
"text" : "CPT Procedure Code",
"type" : "choice",
"required" : true,
"repeats" : false
},
{
"linkId" : "procedure-duration",
"text" : "Procedure duration",
"type" : "quantity",
"required" : true,
"repeats" : false
}
]
},
{
"linkId" : "general-anesthesia",
"text" : "General anesthesia",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "surgeon-code",
"text" : "Surgeon code",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "nhsn-comment",
"code" : [
{
"system" : "http://www.loinc.org",
"code" : "86468-6",
"display" : "Report Comment Section"
}
],
"text" : "Comments",
"type" : "text",
"required" : false,
"repeats" : false,
"maxLength" : 2000
}
]
}
