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-opc-sdom-event

Raw xml 


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="hai-questionnaire-opc-sdom-event"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2019-03-11T00:49:08.000-04:00"/>
    <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 Outpatient Procedure Component Same Day Outcome Measures Event 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-opc-sdom-event</td>
          </tr>
          <tr>
            <td>Version</td>
            <td>R1</td>
          </tr>
          <tr>
            <td>title</td>
            <td>Outpatient Procedure Component Same Day Outcome Measures Event Report</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>Facility ID</td>
            <td>url</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Date of Encounter (Admission)</td>
            <td>date</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td/>
            <td>Same Day Outcome Measures Event Details</td>
            <td>group</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Patient burn</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Patient fall</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Hospital transfer/admission</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Wrong site</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Wrong side</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Wrong patient</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Wrong procedure</td>
            <td>boolen</td>
            <td>true</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Same Day Outcome Measures Event Details</td>
            <td>Wrong implant</td>
            <td>boolen</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-opc-sdom-event"/>
  <identifier>
    <value value="hai-questionnaire-opc-sdom-event-v1"/>
  </identifier>
  <version value="R1"/>
  <name value="hai-questionnaire-opc-sdom-event"/>
  <title
         value="Outpatient Procedure Component Same Day Outcome Measures Event Report"/>
  <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 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 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-id"/>
    <text value="Facility ID"/>
    <type value="url"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="date-of-encounter"/>
    <text value="Date of Encounter (Admission)"/>
    <type value="date"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="same-day-outcome-measures-event-details"/>
    <code>
      <system value="http://loinc.org"/>
      <code value="51899-3"/>
      <display value="Details Document"/>
    </code>
    <text
          value="Same Day Outcome Measures Event Details: Contains details about same-day outcome measures events"/>
    <type value="group"/>
    <repeats value="false"/>
    <item>
      <linkId value="same-day-outcome-measure-patient-burn"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="125666000"/>
        <display value="Burn"/>
      </code>
      <text value="Same Day Outcome Measure: Patient Burn"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-patient-fall"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="217082002"/>
        <display value="Accidental fall"/>
      </code>
      <text value="Same Day Outcome Measure: Patient fall"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-transfer-admission"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1645-1"/>
        <display value="Hospital transer/admission"/>
      </code>
      <text value="Same Day Outcome Measure: Hospital transfer/admission"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-site"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1646-9"/>
        <display value="Wrong site"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong site"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-side"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1647-7"/>
        <display value="Wrong side"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong side"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-patient"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1648-5"/>
        <display value="Wrong patient"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong patient"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-procedure"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="370898007"/>
        <display value="Wrong surgical procedure performed on a patient"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong procedure"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-implant"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1649-3"/>
        <display value="Wrong implant"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong implant"/>
      <type value="boolean"/>
      <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>