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-sdom-event
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireResponse-opc-sdom-event",
"meta" : {
"versionId" : "6",
"lastUpdated" : "2019-03-13T20:46:59.000-04:00",
"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 Same Day Outcome Measures Event Report and is in response to the Questionnaire instance defining this report.</p>\n <h2>Example Outpatient Procedure Component Same Day Outcome Measures Event Report</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>First day of period reported</td>\n <td>2018-06-01</td>\n </tr>\n <tr>\n <td>Date of Encounter (Admission)</td>\n <td>2018-08-05</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>Same Day Outcome Measures Event Details</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Patient burn</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Patient fall</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Hospital transfer/admission</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Wrong site</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Wrong side</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Wrong patient</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Wrong procedure</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Wrong implant</td>\n <td>false</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" : "20202205"
},
"questionnaire" : {
"reference" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-sdom-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-id",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1"
}
]
},
{
"linkId" : "date-of-encounter",
"text" : "Date of Encounter (Admission)",
"answer" : [
{
"valueDate" : "2018-08-05"
}
]
},
{
"linkId" : "same-day-outcome-measures-event-details",
"text" : "Same Day Outcome Measures Event Details: Contains details about same-day outcome measures events",
"item" : [
{
"linkId" : "same-day-outcome-measure-patient-burn",
"text" : "Same Day Outcome Measure: Patient Burn",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "same-day-outcome-measure-patient-fall",
"text" : "Same Day Outcome Measure: Patient fall",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "same-day-outcome-transfer-admission",
"text" : "Same Day Outcome Measure: Hospital transfer/admission",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "same-day-outcome-measure-wrong-site",
"text" : "Same Day Outcome Measure: Wrong site",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "same-day-outcome-measure-wrong-side",
"text" : "Same Day Outcome Measure: Wrong side",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "same-day-outcome-measure-wrong-patient",
"text" : "Same Day Outcome Measure: Wrong patient",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "same-day-outcome-measure-wrong-procedure",
"text" : "Same Day Outcome Measure: Wrong procedure",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "same-day-outcome-measure-wrong-implant",
"text" : "Same Day Outcome Measure: Wrong implant",
"answer" : [
{
"valueBoolean" : false
}
]
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
