This page is part of the Healthcare Associated Infection Implementation Guide (v1.0.0: STU 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
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:oid: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. |