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-event
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireResponse-los-event",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-05T16:59:54.000-05:00",
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire-response"
]
},
"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 Event (LOS) Report and is in response to the Questionnaire instance defining this report.</p>\n <h2>Example Late Onset Sepsis/Meningitis Event (LOS)</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>Facility ID</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W</td>\n </tr>\n <tr>\n <td>Event #</td>\n <td>urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31</td>\n </tr>\n <tr>\n <td>Event Type</td>\n <td>Late onset sepsis (LOS)</td>\n </tr>\n <tr>\n <td>Date of Event</td>\n <td>2018-01-02</td>\n </tr>\n <tr>\n <td>Date Admitted to Facility</td>\n <td>2018-01-01</td>\n </tr>\n <tr>\n <td>Inborn/Outborn</td>\n <td>Inborn</td>\n </tr>\n <tr>\n <td>Location</td>\n <td>Medical/Surgical Critical Care</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>Social Security #</td>\n <td>12345</td>\n </tr>\n <tr>\n <td>Medicaid #</td>\n <td>959595</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>2018-01-01</td>\n </tr>\n <tr>\n <td>Ethnicity</td>\n <td>Not Hispanic or Latino</td>\n </tr>\n <tr>\n <td>Race</td>\n <td>White</td>\n </tr>\n </tbody>\n </table>\n \n <h3>Risk Factors</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Central line present prior to event, including umbilical catheter</td>\n <td>Yes</td>\n </tr>\n <tr>\n <td>Birth Weight</td>\n <td>700 g</td>\n </tr>\n <tr>\n <td>Gestational Age</td>\n <td>276 d</td>\n </tr>\n </tbody>\n </table>\n <h3>Event Details</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Specific Event</td>\n <td>Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)</td>\n </tr>\n <tr>\n <td>Criteria used</td>\n <td>Recognized pathogen from one or more blood specimens</td>\n </tr>\n <tr>\n <td>Died</td>\n <td>Yes</td>\n </tr>\n <tr>\n <td>LOS Contributed to Death</td>\n <td>No</td>\n </tr>\n <tr>\n <td>Discharge date</td>\n <td>2018-01-12</td>\n </tr>\n </tbody>\n </table>\n <h3>Findings</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Microorganism identified</td>\n <td>Clostridium symbiosum (organism)</td>\n </tr>\n <tr>\n <td>Pathogen Ranking</td>\n <td>First</td>\n </tr>\n <tr>\n <td>Clarithro Susc Islt</td>\n <td>Resistant</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" : "20202201"
},
"questionnaire" : {
"reference" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event"
},
"status" : "completed",
"subject" : {
"reference" : "Patient/hai-patient-1",
"display" : "hai-patient-1"
},
"author" : {
"reference" : "Device/hai-authoring-device",
"display" : "hai-authoring-device"
},
"item" : [
{
"linkId" : "facility",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W"
}
]
},
{
"linkId" : "event-number",
"text" : "Event #",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31"
}
]
},
{
"linkId" : "event-type",
"text" : "Event Type",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "765107002",
"display" : "Late-onset neonatal sepsis (disorder)"
}
}
]
},
{
"linkId" : "date-of-event",
"text" : "Date of Event",
"answer" : [
{
"valueDate" : "2018-01-02"
}
]
},
{
"linkId" : "facility-location",
"text" : "Facility Location",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259",
"code" : "1029-8",
"display" : "Medical/Surgical Critical Care"
}
}
]
},
{
"linkId" : "date-admitted-to-facility",
"text" : "Date Admitted to Facility:",
"answer" : [
{
"valueDate" : "2018-01-01"
}
]
},
{
"linkId" : "inborn-outborn-observation",
"text" : "Inborn/Outborn: If the infant was outborn (born at a location other than the reporting hospital), select true. If the infant was inborn (born at the reporting hospital) select false.",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "risk-factors",
"text" : "Risk Factors: Contains central line present, birth weight, gestational age",
"item" : [
{
"linkId" : "risk-factor-central-line",
"text" : "Risk Factor: Central line present prior to event, including umbilical catheter",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "risk-factor-birth-weight",
"text" : "Risk Factor: Birth weight (grams)",
"answer" : [
{
"valueQuantity" : {
"value" : 700,
"unit" : "g"
}
}
]
},
{
"linkId" : "risk-factor-gestational-age",
"text" : "Risk Factor: Gestational age (days)",
"answer" : [
{
"valueQuantity" : {
"value" : 276,
"unit" : "d"
}
}
]
}
]
},
{
"linkId" : "event-details",
"text" : "Event Details",
"item" : [
{
"linkId" : "infection-condition",
"text" : "Specific Event",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3067-6",
"display" : "Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)"
}
}
]
},
{
"linkId" : "criteria-used",
"text" : "Laboratory Criteria Used",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1951-3",
"display" : "Recognized pathogen from one or more blood cultures"
}
}
]
},
{
"linkId" : "died",
"text" : "Died",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "discharge-date",
"text" : "Discharge Date",
"answer" : [
{
"valueDate" : "2018-01-12"
}
]
}
]
},
{
"linkId" : "findings-group",
"text" : "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "48321006",
"display" : "Clostridium symbiosum (organism)"
}
}
]
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "255216001",
"display" : "First"
}
}
]
},
{
"linkId" : "drug-susceptibility-test-group",
"text" : "Drug Susceptibility Test Group",
"item" : [
{
"linkId" : "drug-susceptibility-test",
"text" : "Drug Susceptibility Test",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "18907-6",
"display" : "Clarithro Susc Islt"
}
}
]
},
{
"linkId" : "drug-susceptibility-test-interpretation",
"text" : "Drug Susceptibility Test Interpretation",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/v3/ObservationInterpretation",
"code" : "R",
"display" : "Resistant"
}
}
]
}
]
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
