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-opc-proc-denom
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireResponse-opc-proc-denom",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-13T23:52:39.000-04:00",
"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 Outpatient Procedure Component Denominator for Procedure and is in response to the Questionnaire instance defining this report.</p>\n <h2>Example Outpatient Procedure Component Denominator for Procedure</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</td>\n </tr>\n <tr>\n <td>Event Number</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31</td>\n </tr>\n <tr>\n <td>Date of encounter</td>\n <td>2018-12-23</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>1954-11-25</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 <h3>Risk Factors</h3>\n <table border=\"1\">\n <tbody> \n <tr>\n <td>Wound class</td>\n <td>CDC Class II/Clean-contaminated</td>\n </tr>\n <tr>\n <td>Endoscopy used</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Diabetes mellitus</td>\n <td>false</td>\n </tr>\n <tr>\n <td>height</td>\n <td>168 cm</td>\n </tr>\n <tr>\n <td>height</td>\n <td>68 kg</td>\n </tr>\n <tr>\n <td>ASA Class</td>\n <td>ASA physical status class 1</td>\n </tr>\n </tbody>\n </table>\n <h3>Procedure Details</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>NHSN Procedure Code Category</td>\n <td>2108-9: Appendix surgery</td>\n </tr>\n <tr>\n <td>CPT Procedure Code</td>\n <td>44970: Laparoscopic Procedures on the Appendix</td>\n </tr>\n <tr>\n <td>Procedure duration</td>\n <td>90 min</td>\n </tr>\n <tr>\n <td>General anesthesia</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Surgeon code</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1.1:987654</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" : "20202209"
},
"questionnaire" : {
"reference" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-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" : "facility-id",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1"
}
]
},
{
"linkId" : "event-number",
"text" : "Event Number",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31"
}
]
},
{
"linkId" : "encounter-date",
"text" : "Date of encounter",
"answer" : [
{
"valueDate" : "2018-12-23"
}
]
},
{
"linkId" : "risk-factors",
"text" : "Risk Factors",
"item" : [
{
"linkId" : "risk-factor-wound-class",
"text" : "Risk Factor: Wound class",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "418115006",
"display" : "CDC Class II/Clean-contaminated"
}
}
]
},
{
"linkId" : "risk-factor-endoscopy",
"text" : "Risk Factor: Endoscopy used",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "risk-factor-diabetes-mellitus",
"text" : "Risk Factor: Diabetes mellitus",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "risk-factor-height",
"text" : "Risk Factor: height",
"answer" : [
{
"valueQuantity" : {
"value" : 168,
"unit" : "cm"
}
}
]
},
{
"linkId" : "risk-factor-weight",
"text" : "Risk Factor: height",
"answer" : [
{
"valueQuantity" : {
"value" : 68,
"unit" : "kg"
}
}
]
},
{
"linkId" : "risk-factor-asa-class",
"text" : "Risk Factor: ASA Class",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "413495001",
"display" : "ASA physical status class 1"
}
}
]
}
]
},
{
"linkId" : "procedure-details",
"text" : "Procedure Details",
"item" : [
{
"linkId" : "nhsn-procedure-code-category",
"text" : "NHSN Procedure Code Category",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "2108-9",
"display" : "Appendix surgery"
}
}
]
},
{
"linkId" : "cpt-procedure-code",
"text" : "CPT Procedure Code",
"answer" : [
{
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "44970",
"display" : "Laparoscopic Procedures on the Appendix"
}
}
]
},
{
"linkId" : "procedure-duration",
"text" : "Procedure duration",
"answer" : [
{
"valueQuantity" : {
"value" : 65,
"unit" : "min"
}
}
]
}
]
},
{
"linkId" : "general-anesthesia",
"text" : "General anesthesia",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "surgeon-code",
"text" : "Surgeon code",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1.1:987654"
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
