NHSN Healthcare Associated Infection (HAI) Reports
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This page is part of the Healthcare Associated Infection Implementation Guide (v2.1.0: STU2) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Questionnaire - Outpatient Procedure Component Denominator for Procedure - JSON Representation

Active as of 2019-04-01

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{
  "resourceType" : "Questionnaire",
  "id" : "hai-questionnaire-opc-proc-denom",
  "meta" : {
    "versionId" : "11",
    "lastUpdated" : "2023-02-24T01:35:54.128+00:00",
    "source" : "#QYbd8C4welZ3TEoO",
    "profile" : [
      "http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"
    ]
  },
  "language" : "en-US",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Placeholder</div>"
  },
  "url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom",
  "identifier" : [
    {
      "value" : "hai-questionnaire-opc-proc-denom-v1"
    }
  ],
  "name" : "HAI_questionnaire_opc_proc_denom",
  "title" : "Outpatient Procedure Component Denominator for Procedure",
  "status" : "active",
  "experimental" : false,
  "subjectType" : [
    "Patient"
  ],
  "date" : "2019-04-01",
  "publisher" : "HL7 International - Structured Documents Work Group",
  "contact" : [
    {
      "name" : "HL7 International - Structured Documents",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/structure"
        }
      ]
    }
  ],
  "description" : "This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Denominator for Procedure. This report records date on each patient having one of the NHSN procedures selected for monitoring.\n\nFor further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website [https://www.cdc.gov/nhsn/](https://www.cdc.gov/nhsn/).\n",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ],
      "text" : "United States of America"
    }
  ],
  "code" : [
    {
      "system" : "http://loinc.org",
      "code" : "51897-7",
      "display" : "Healthcare Associated Infection report Document"
    }
  ],
  "item" : [
    {
      "linkId" : "facility-id",
      "text" : "Facility ID",
      "type" : "url",
      "required" : true,
      "repeats" : false
    },
    {
      "linkId" : "encounter-date",
      "text" : "Date of encounter",
      "type" : "date",
      "required" : true,
      "repeats" : false
    },
    {
      "linkId" : "risk-factors",
      "code" : [
        {
          "system" : "http://loinc.org",
          "code" : "51898-5",
          "display" : "Risk factors Document"
        }
      ],
      "text" : "Risk Factors",
      "type" : "group",
      "required" : true,
      "repeats" : false,
      "item" : [
        {
          "linkId" : "risk-factors-group-description",
          "text" : "This group contains procedure risk factors such as ASA class, diabetes mellitus, height, and weight.",
          "type" : "display"
        },
        {
          "linkId" : "risk-factor-wound-class",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "420089007",
              "display" : "CDC wound classification category"
            }
          ],
          "text" : "Risk Factor: Wound class",
          "type" : "choice",
          "required" : false,
          "repeats" : false,
          "answerValueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.9"
        },
        {
          "linkId" : "risk-factor-endoscopy",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "423827005",
              "display" : "Endoscopy"
            }
          ],
          "text" : "Risk Factor: Endoscopy used",
          "type" : "boolean",
          "required" : true,
          "repeats" : false
        },
        {
          "linkId" : "risk-factor-diabetes-mellitus",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "73211009",
              "display" : "Diabetes mellitus"
            }
          ],
          "text" : "Risk Factor: Diabetes mellitus",
          "type" : "boolean",
          "required" : true,
          "repeats" : false
        },
        {
          "linkId" : "risk-factor-height",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "50373000",
              "display" : "Body Height"
            }
          ],
          "text" : "Risk Factor: height",
          "type" : "quantity",
          "required" : true,
          "repeats" : false
        },
        {
          "linkId" : "risk-factor-weight",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "27113001",
              "display" : "Body Weight"
            }
          ],
          "text" : "Risk Factor: weight",
          "type" : "quantity",
          "required" : true,
          "repeats" : false
        },
        {
          "linkId" : "risk-factor-asa-class",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "273270000",
              "display" : "American Society of Anesthesiologists physical status classification (assessment scale)"
            }
          ],
          "text" : "Risk Factor: ASA Class",
          "type" : "choice",
          "required" : true,
          "repeats" : false,
          "answerValueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.10"
        }
      ]
    },
    {
      "linkId" : "procedure-details",
      "code" : [
        {
          "system" : "http://loinc.org",
          "code" : "51899-3",
          "display" : "Details Document"
        }
      ],
      "text" : "Procedure Details",
      "type" : "group",
      "required" : true,
      "repeats" : false,
      "item" : [
        {
          "linkId" : "procedure-details-group-description",
          "text" : "This group contains details about the procedure.",
          "type" : "display"
        },
        {
          "linkId" : "procedure-id",
          "text" : "Procedure ID",
          "type" : "url",
          "required" : true,
          "repeats" : false
        },
        {
          "linkId" : "nhsn-procedure-code-category",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "29300-1",
              "display" : "Procedure type"
            }
          ],
          "text" : "NHSN Procedure Code Category",
          "type" : "choice",
          "required" : true,
          "repeats" : false,
          "answerValueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.10.20.5.9.34"
        },
        {
          "linkId" : "cpt-procedure-code",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "76448-0",
              "display" : "CPT billing code"
            }
          ],
          "text" : "CPT Procedure Code",
          "type" : "choice",
          "required" : true,
          "repeats" : false,
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/cpt-all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
              "valueCoding" : {
                "system" : "http://unitsofmeasure.org",
                "code" : "min",
                "display" : "min"
              }
            }
          ],
          "linkId" : "procedure-duration",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "89875-9",
              "display" : "Procedure duration"
            }
          ],
          "text" : "Procedure duration (in minutes)",
          "type" : "quantity",
          "required" : true,
          "repeats" : false
        }
      ]
    },
    {
      "linkId" : "general-anesthesia",
      "text" : "General anesthesia",
      "type" : "boolean",
      "required" : true,
      "repeats" : false
    },
    {
      "linkId" : "surgeon-code",
      "text" : "Surgeon code",
      "type" : "url",
      "required" : true,
      "repeats" : false
    },
    {
      "linkId" : "nhsn-comment",
      "code" : [
        {
          "system" : "http://loinc.org",
          "code" : "86468-6",
          "display" : "Report Comment Section"
        }
      ],
      "text" : "Comments",
      "type" : "text",
      "required" : false,
      "repeats" : false,
      "maxLength" : 2000
    }
  ]
}