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-sdom-event
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-questionnaire-opc-sdom-event",
"meta" : {
"versionId" : "2",
"lastUpdated" : "2019-03-11T00:49:08.000-04:00",
"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 Same Day Outcome Measures Event Report. It records a late onset sepsis/meningitis infection event.\n <br/>For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present.\n </p>\n <h2>Late Onset Sepsis/Meningitis Event (LOS) Instance Details</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-sdom-event</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 Same Day Outcome Measures Event Report</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>Date of Encounter (Admission)</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Same Day Outcome Measures Event Details</td>\n <td>group</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Patient burn</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Patient fall</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Hospital transfer/admission</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Wrong site</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Wrong side</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Wrong patient</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Wrong procedure</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Same Day Outcome Measures Event Details</td>\n <td>Wrong implant</td>\n <td>boolen</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Comments</td>\n <td>text</td>\n <td>false</td>\n <td>false</td>\n </tr>\n </tbody>\n </table>\n </div>"
},
"url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-sdom-event",
"identifier" : [
{
"value" : "hai-questionnaire-opc-sdom-event-v1"
}
],
"version" : "R1",
"name" : "hai-questionnaire-opc-sdom-event",
"title" : "Outpatient Procedure Component Same Day Outcome Measures Event Report",
"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 Same Day Outcome Measures Event Report. It records data on each patient who experienced one or more of the same day outcome measures events.",
"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" : "date-of-encounter",
"text" : "Date of Encounter (Admission)",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measures-event-details",
"code" : [
{
"system" : "http://loinc.org",
"code" : "51899-3",
"display" : "Details Document"
}
],
"text" : "Same Day Outcome Measures Event Details: Contains details about same-day outcome measures events",
"type" : "group",
"repeats" : false,
"item" : [
{
"linkId" : "same-day-outcome-measure-patient-burn",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "125666000",
"display" : "Burn"
}
],
"text" : "Same Day Outcome Measure: Patient Burn",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-patient-fall",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "217082002",
"display" : "Accidental fall"
}
],
"text" : "Same Day Outcome Measure: Patient fall",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-transfer-admission",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1645-1",
"display" : "Hospital transer/admission"
}
],
"text" : "Same Day Outcome Measure: Hospital transfer/admission",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-site",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1646-9",
"display" : "Wrong site"
}
],
"text" : "Same Day Outcome Measure: Wrong site",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-side",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1647-7",
"display" : "Wrong side"
}
],
"text" : "Same Day Outcome Measure: Wrong side",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-patient",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1648-5",
"display" : "Wrong patient"
}
],
"text" : "Same Day Outcome Measure: Wrong patient",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-procedure",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "370898007",
"display" : "Wrong surgical procedure performed on a patient"
}
],
"text" : "Same Day Outcome Measure: Wrong procedure",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-implant",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1649-3",
"display" : "Wrong implant"
}
],
"text" : "Same Day Outcome Measure: Wrong implant",
"type" : "boolean",
"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
}
]
}
