This page is part of the Healthcare Associated Infection Implementation Guide (v2.0.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions
Questionnaire: hai-questionnaire-los-event
Late Onset Sepsis/Meningitis Event (LOS)
This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Report. It records a late onset sepsis/meningitis infection event. For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present.
For further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website https://www.cdc.gov/nhsn/.
Questionnaire Details
Id: | hai-questionnaire-los-event |
Profile: | http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire |
Language: | en-US |
Url: | http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event |
Identifier: | hai-questionnaire-los-event-v2 |
Version: | Version: 2.0.0 |
Name: | HAI_questionnaire_los_event |
Status: | draft |
Subject Type: | Patient (Source Patient Resource (US Core Patient)) |
Date: | 2019-04-01 |
Publisher: | HL7 Structured Documents Work Group |
Jurisdiction: | Code: US |
Code: |
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Questionnaire Items (* required)
- * Facility ID [facility] (url)
- Event Number [event-number] (url)
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*
Event Type [event-type] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20
- * Date of Event [date-of-event] (date)
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*
Facility Location [facility-location] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.19
- * Date Admitted to Facility: [date-admitted-to-facility] (date)
- * Inborn/Outborn: If the infant was outborn (born at a location other than the reporting hospital), select true. If the infant was inborn (born at the reporting hospital) select false. [inborn-outborn-observation] (boolean)
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*
Risk Factors [risk-factors] (group)
- This group contains risk factors such as central line present, birth weight, and gestational age. [risk-factors-group] (display)
- Risk Factor: Central line present prior to event, including umbilical catheter [risk-factor-central-line] (boolean)
- * Risk Factor: Birth weight (grams) [risk-factor-birth-weight] (quantity)
- * Gestational age known: set true if known and false if unknown [gestational-age-known] (boolean)
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Risk Factor: Gestational age (days) [risk-factor-gestational-age] (quantity)
- Enable when: gestational-age-known = "true"
- Enable when: gestational-age-known = "true"
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*
Event Details [event-details] (group)
- This group contains details aboout the late onset septis infection event. [event-details-group] (display)
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*
Specific Event [infection-condition] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196
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*
Laboratory Criteria Used [criteria-used] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3195
- * Died [died] (boolean)
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Infection contributed to death [los-contributed-to-death] (boolean)
- Enable when: died = "true"
- Enable when: died = "true"
- Discharge Date [discharge-date] (date)
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*
Findings Group [findings-group] (group, repeats)
- This group records whether infection organisms were identified and, if so, records details about them. [findings-group-description] (display)
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*
Pathogen Identified [pathogen-identified] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16
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*
Pathogen Ranking [pathogen-ranking] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking
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Drug Susceptibility Test Group [drug-susceptibility-test-group] (group, repeats)
- This group contains drug-susceptibility information such as the drug and the pathogen's susceptibility to it. [drug-susceptibility-test-group-description] (display)
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*
Drug Susceptibility Test [drug-susceptibility-test] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.15
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Drug Susceptibility Test Interpretation [drug-susceptibility-test-interpretation] (choice)
- answerValueSet: http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.13
- Comments [nhsn-comment] (text)