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: QuestionnaireResponse-hai-questionnaireResponse-los-event

Raw xml 


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