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-sdom-event

Raw xml 


<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="hai-questionnaireResponse-opc-sdom-event"/>
  <meta>
    <versionId value="6"/>
    <lastUpdated value="2019-03-13T20:46:59.000-04:00"/>
    <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 Same Day Outcome Measures Event Report and is in response to the Questionnaire instance defining this report.</p>
      <h2>Example Outpatient Procedure Component Same Day Outcome Measures Event Report</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>First day of period reported</td>
            <td>2018-06-01</td>
          </tr>
          <tr>
            <td>Date of Encounter (Admission)</td>
            <td>2018-08-05</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>Same Day Outcome Measures Event Details</h3>
      <table border="1">
        <tbody>
          <tr>
            <td>Patient burn</td>
            <td>true</td>
          </tr>
          <tr>
            <td>Patient fall</td>
            <td>true</td>
          </tr>
          <tr>
            <td>Hospital transfer/admission</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Wrong site</td>
            <td>true</td>
          </tr>
          <tr>
            <td>Wrong side</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Wrong patient</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Wrong procedure</td>
            <td>false</td>
          </tr>
          <tr>
            <td>Wrong implant</td>
            <td>false</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="20202205"/>
  </identifier>
  <questionnaire>
    <reference
               value="http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-sdom-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-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="date-of-encounter"/>
    <text value="Date of Encounter (Admission)"/>
    <answer>
      <valueDate value="2018-08-05"/>
    </answer>
  </item>
  <item>
    <linkId value="same-day-outcome-measures-event-details"/>
    <text
          value="Same Day Outcome Measures Event Details: Contains details about same-day outcome measures events"/>
    <item>
      <linkId value="same-day-outcome-measure-patient-burn"/>
      <text value="Same Day Outcome Measure: Patient Burn"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-patient-fall"/>
      <text value="Same Day Outcome Measure: Patient fall"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-transfer-admission"/>
      <text value="Same Day Outcome Measure: Hospital transfer/admission"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-site"/>
      <text value="Same Day Outcome Measure: Wrong site"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-side"/>
      <text value="Same Day Outcome Measure: Wrong side"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-patient"/>
      <text value="Same Day Outcome Measure: Wrong patient"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-procedure"/>
      <text value="Same Day Outcome Measure: Wrong procedure"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-implant"/>
      <text value="Same Day Outcome Measure: Wrong implant"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </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>