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: QuestionnaireResponse-hai-questionnaireResponse-los-denom
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireResponse-los-denom",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-13T22:23:28.000-04:00",
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire-response"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <p>This QuestionnaireResponse instance is an example of a completed Late Onset Sepsis/Meningitis Denominator and is in response to the Questionnaire instance defining this report.</p>\n <h2>Example Late Onset Sepsis/Meningitis Denominator</h2>\n <h3>Authoring and Facility Information</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Authoring Device</td>\n <td>Id: 2.16.840.1.113883.3.117.1.1.5.1.1.2:anAuthorID</td>\n </tr>\n <tr>\n <td>Year and month data collected for this location</td>\n <td>2019-01</td>\n </tr>\n <tr>\n <td>Facility ID</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1</td>\n </tr>\n <tr>\n <td>Date Admitted to Facility</td>\n <td>2019-01-01</td>\n </tr>\n </tbody>\n </table>\n <h3>Patient</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Patient ID</td>\n <td>Medical Record Number: 12345</td>\n </tr>\n <tr>\n <td>Patient Last Name</td>\n <td>Nuclear</td>\n </tr>\n <tr>\n <td>Patient First Name</td>\n <td>Ned</td>\n </tr>\n <tr>\n <td>Gender</td>\n <td>Male</td>\n </tr>\n <tr>\n <td>Date of Birth</td>\n <td>2019-01-01</td>\n </tr>\n </tbody>\n </table>\n <h3>Location Within Facility Encounter</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Facility Location Type</td>\n <td>Neonatal Critical Care(Level II/III)</td>\n </tr>\n <tr>\n <td>Facility Location</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:NICU</td>\n </tr>\n <tr>\n <td>Date admitted or transferred to location</td>\n <td>2019-01-01</td>\n </tr>\n <tr>\n <td>Disposition of infant</td>\n <td>No location change</td>\n </tr>\n <tr>\n <td>Disposition date if discharged, transferred, or expired</td>\n <td>n/a</td>\n </tr>\n </tbody>\n </table>\n <h3>Risk Factors</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Birth weight (grams)</td>\n <td>700 grams</td>\n </tr>\n <tr>\n <td>Gestational age (days)</td>\n <td>276 days</td>\n </tr>\n </tbody>\n </table>\n <h3>Comment</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Comment</td>\n <td>NHSN text comment that is less than 2000 characters.</td>\n </tr>\n </tbody>\n </table>\n </div>"
},
"identifier" : {
"system" : "urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.2",
"value" : "20202206"
},
"questionnaire" : {
"reference" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom"
},
"status" : "completed",
"subject" : {
"reference" : "Patient/hai-patient-1",
"display" : "hai-patient-1"
},
"author" : {
"reference" : "Device/hai-authoring-device",
"display" : "hai-authoring-device"
},
"item" : [
{
"linkId" : "date-collected",
"text" : "Year and month data collected for this location",
"answer" : [
{
"valueDate" : "2019-01"
}
]
},
{
"linkId" : "facility",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1"
}
]
},
{
"linkId" : "date-admitted-to-facility",
"text" : "Date Admitted to Facility",
"answer" : [
{
"valueDate" : "2019-01-01"
}
]
},
{
"linkId" : "location-within-facility-encounter-group",
"text" : "Location Within Facility Encounter",
"item" : [
{
"linkId" : "facility-location-type",
"text" : "Facility Location Type",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259",
"code" : "1039-7",
"display" : "Neonatal Critical Care(Level II/III)"
}
}
]
},
{
"linkId" : "facility-location",
"text" : "Facility Location",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:NICU"
}
]
},
{
"linkId" : "location-admit-transfer-date",
"text" : "Date admitted or transferred to location",
"answer" : [
{
"valueDate" : "2019-01-01"
}
]
},
{
"linkId" : "infant-disposition",
"text" : "Disposition of infant",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1311-0",
"display" : "No location change"
}
}
]
}
]
},
{
"linkId" : "risk-factors",
"text" : "Risk Factors: Contains birth weight and gestational age",
"item" : [
{
"linkId" : "risk-factor-birth-weight",
"text" : "Risk Factor: Birth weight (grams)",
"answer" : [
{
"valueQuantity" : {
"value" : 700
}
}
]
},
{
"linkId" : "risk-factor-gestational-age",
"text" : "Risk Factor: Gestational age (days)",
"answer" : [
{
"valueQuantity" : {
"value" : 276
}
}
]
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
