HealthcareAssociatedInfectionReports Implementation Guide CI Build

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:
  • Healthcare Associated Infection report Document
  • Code system: http://loinc.org
  • Code: 51897-7


Questionnaire Items (* required)

  • * Facility ID [facility] (url)
  • Event Number [event-number] (url)
  • * Event Type [event-type] (choice)
  • * Date of Event [date-of-event] (date)
  • * Facility Location [facility-location] (choice)
  • * 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)
  • * 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)
    • Risk Factor: Gestational age (days) [risk-factor-gestational-age] (quantity)
      • Enable when: gestational-age-known = "true"
  • * Event Details [event-details] (group)
  • * Findings Group [findings-group] (group, repeats)
  • Comments [nhsn-comment] (text)