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: QuestionnaireResponse-hai-questionnaireResponse-los-denom
Raw xml
<QuestionnaireResponse xmlns="http://hl7.org/fhir"> <id value="hai-questionnaireResponse-los-denom"/> <meta> <versionId value="1"/> <lastUpdated value="2019-03-13T22:23:28.000-04:00"/> <profile value="http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire-response"/> </meta> <language value="en-US"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml" lang="en-US"> <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> <h2>Example Late Onset Sepsis/Meningitis Denominator</h2> <h3>Authoring and Facility Information</h3> <table border="1"> <tbody> <tr> <td>Authoring Device</td> <td>Id: 2.16.840.1.113883.3.117.1.1.5.1.1.2:anAuthorID</td> </tr> <tr> <td>Year and month data collected for this location</td> <td>2019-01</td> </tr> <tr> <td>Facility ID</td> <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1</td> </tr> <tr> <td>Date Admitted to Facility</td> <td>2019-01-01</td> </tr> </tbody> </table> <h3>Patient</h3> <table border="1"> <tbody> <tr> <td>Patient ID</td> <td>Medical Record Number: 12345</td> </tr> <tr> <td>Patient Last Name</td> <td>Nuclear</td> </tr> <tr> <td>Patient First Name</td> <td>Ned</td> </tr> <tr> <td>Gender</td> <td>Male</td> </tr> <tr> <td>Date of Birth</td> <td>2019-01-01</td> </tr> </tbody> </table> <h3>Location Within Facility Encounter</h3> <table border="1"> <tbody> <tr> <td>Facility Location Type</td> <td>Neonatal Critical Care(Level II/III)</td> </tr> <tr> <td>Facility Location</td> <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:NICU</td> </tr> <tr> <td>Date admitted or transferred to location</td> <td>2019-01-01</td> </tr> <tr> <td>Disposition of infant</td> <td>No location change</td> </tr> <tr> <td>Disposition date if discharged, transferred, or expired</td> <td>n/a</td> </tr> </tbody> </table> <h3>Risk Factors</h3> <table border="1"> <tbody> <tr> <td>Birth weight (grams)</td> <td>700 grams</td> </tr> <tr> <td>Gestational age (days)</td> <td>276 days</td> </tr> </tbody> </table> <h3>Comment</h3> <table border="1"> <tbody> <tr> <td>Comment</td> <td>NHSN text comment that is less than 2000 characters.</td> </tr> </tbody> </table> </div> </text> <identifier> <system value="urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.2"/> <value value="20202206"/> </identifier> <questionnaire> <reference value="http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom"/> </questionnaire> <status value="completed"/> <subject> <reference value="Patient/hai-patient-1"/> <display value="hai-patient-1"/> </subject> <author> <reference value="Device/hai-authoring-device"/> <display value="hai-authoring-device"/> </author> <item> <linkId value="date-collected"/> <text value="Year and month data collected for this location"/> <answer> <valueDate value="2019-01"/> </answer> </item> <item> <linkId value="facility"/> <text value="Facility ID"/> <answer> <valueUri value="urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1"/> </answer> </item> <item> <linkId value="date-admitted-to-facility"/> <text value="Date Admitted to Facility"/> <answer> <valueDate value="2019-01-01"/> </answer> </item> <!-- <item> <linkId value="disposition-date"/> <text value="Disposition date if discharged, transferred, or expired"/> <answer> <valueDate value="2019-01-02"/> </answer> </item> --> <item> <linkId value="location-within-facility-encounter-group"/> <text value="Location Within Facility Encounter"/> <item> <linkId value="facility-location-type"/> <text value="Facility Location Type"/> <answer> <valueCoding> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259"/> <code value="1039-7"/> <display value="Neonatal Critical Care(Level II/III)"/> </valueCoding> </answer> </item> <item> <linkId value="facility-location"/> <text value="Facility Location"/> <answer> <valueUri value="urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:NICU"/> </answer> </item> <item> <linkId value="location-admit-transfer-date"/> <text value="Date admitted or transferred to location"/> <answer> <valueDate value="2019-01-01"/> </answer> </item> <item> <linkId value="infant-disposition"/> <text value="Disposition of infant"/> <answer> <valueCoding> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1311-0"/> <display value="No location change"/> </valueCoding> </answer> </item> </item> <item> <linkId value="risk-factors"/> <text value="Risk Factors: Contains birth weight and gestational age"/> <item> <linkId value="risk-factor-birth-weight"/> <text value="Risk Factor: Birth weight (grams)"/> <answer> <valueQuantity> <value value="700"/> </valueQuantity> </answer> </item> <item> <linkId value="risk-factor-gestational-age"/> <text value="Risk Factor: Gestational age (days)"/> <answer> <valueQuantity> <value value="276"/> </valueQuantity> </answer> </item> </item> <item> <linkId value="nhsn-comment"/> <text value="Comments"/> <answer> <valueString value="NHSN text comment that is less than 2000 characters."/> </answer> </item> </QuestionnaireResponse>
