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.

Late Onset Sepsis/Meningitis Event (LOS)

Facility ID	urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W
Event #	urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31
Patient ID	Medical Record Number: 12345
Social Security #	12345
Medicaid #	959595
Patient Last Name	Nuclear
Patient First Name	Ned
Gender	Male
Date of Birth	1954-11-25
Ethnicity	Not Hispanic or Latino
Race	White
Event Type	Late onset sepsis (LOS)
Date of Event	2018-01-02
Date Admitted to Facility	2018-01-01
Inborn/Outborn	Inborn
Location	Medical/Surgical Critical Care

Risk Factors

Central line present prior to event, including umbilical catheter	Yes
Birth Weight	700 g
Gestational Age	276 d

Event Details

Specific Event	Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)
Criteria used	Recognized pathogen from one or more blood specimens
Died	Yes
LOS Contributed to Death	No
Discharge date	2018-01-12

Findings

Microorganism identified	Clostridium symbiosum (organism)
Pathogen Ranking	First
Clarithro Susc Islt	Resistant

Comment

Comment

NHSN text comment that is less than 2000 characters.

---

Patient ID	Medical Record Number: 12345
Social Security #	12345
Medicaid #	959595
Patient Last Name	Nuclear
Patient First Name	Ned
Gender	Male
Date of Birth	1954-11-25
Ethnicity	Not Hispanic or Latino
Race	White

---

id: hai-authoring-device

Id: 2.16.840.1.113883.3.117.1.1.5.1.1.2:anAuthorID

---