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-opc-proc-denom

Raw xml 


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