This page is part of the Healthcare Associated Infection Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions 
JSON Format: Questionnaire-hai-questionnaire-opc-proc-denom
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-questionnaire-opc-proc-denom",
"meta" : {
"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\" lang=\"en-US\">\n <h1 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Outpatient Procedure Component Denominator for Procedure</h1>\n <p xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">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.</p>\n <p xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">For further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website <a href=\"https://www.cdc.gov/nhsn/\">https://www.cdc.gov/nhsn/</a>.</p>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Details</h2>\n <table xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <tr>\n <td>\n <b>Id:</b>\n </td>\n <td>hai-questionnaire-opc-proc-denom</td>\n </tr>\n <tr>\n <td>\n <b>Profile:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire</td>\n </tr>\n <tr>\n <td>\n <b>Language:</b>\n </td>\n <td>en-US</td>\n </tr>\n <tr>\n <td>\n <b>Url:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom</td>\n </tr>\n <tr>\n <td>\n <b>Identifier:</b>\n </td>\n <td>\n <span>hai-questionnaire-opc-proc-denom-v1</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Version:</b>\n </td>\n <td>Version: 2.0.0</td>\n </tr>\n <tr>\n <td>\n <b>Name:</b>\n </td>\n <td>HAI_questionnaire_opc_proc_denom</td>\n </tr>\n <tr>\n <td>\n <b>Status:</b>\n </td>\n <td>draft</td>\n </tr>\n <tr>\n <td>\n <b>Experimental:</b>\n </td>\n <td>false</td>\n </tr>\n <tr>\n <td>\n <b>Subject Type:</b>\n </td>\n <td>Patient (Source Patient Resource (US Core Patient))</td>\n </tr>\n <tr>\n <td>\n <b>Date:</b>\n </td>\n <td>2019-04-01</td>\n </tr>\n <tr>\n <td>\n <b>Publisher:</b>\n </td>\n <td>HL7 Structured Documents Work Group</td>\n </tr>\n <tr>\n <td>\n <b>Jurisdiction:</b>\n </td>\n <td>\n <span title=\"Code system: urn:iso:std:iso:3166\">Code: US</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Code:</b>\n </td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>Healthcare Associated Infection report Document</li>\n <li>Code system: <a href=\"http://loinc.org\">http://loinc.org</a>\n </li>\n <li>Code: 51897-7</li>\n </ul>\n </td>\n </tr>\n </table>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Items (<span style=\"color:red\">*</span> required)</h2>\n <ul xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\" style=\"list-style:none;\">\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Facility ID</span> [<span style=\"font-style:italic\">facility-id</span>] (url)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Date of encounter</span> [<span style=\"font-style:italic\">encounter-date</span>] (date)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factors</span> [<span style=\"font-style:italic\">risk-factors</span>] (group)\n <ul style=\"list-style:none;\">\n <li>This group contains procedure risk factors such as ASA class, diabetes mellitus, height, and weight. [<span style=\"font-style:italic\">risk-factors-group-description</span>] (display)\n </li>\n <li>\n <span style=\"font-weight:bold\">Risk Factor: Wound class</span> [<span style=\"font-style:italic\">risk-factor-wound-class</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.9\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.9</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factor: Endoscopy used</span> [<span style=\"font-style:italic\">risk-factor-endoscopy</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factor: Diabetes mellitus</span> [<span style=\"font-style:italic\">risk-factor-diabetes-mellitus</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factor: height</span> [<span style=\"font-style:italic\">risk-factor-height</span>] (quantity)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factor: weight</span> [<span style=\"font-style:italic\">risk-factor-weight</span>] (quantity)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Risk Factor: ASA Class</span> [<span style=\"font-style:italic\">risk-factor-asa-class</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.10\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.10</a>\n </li>\n </ul>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Procedure Details</span> [<span style=\"font-style:italic\">procedure-details</span>] (group)\n <ul style=\"list-style:none;\">\n <li>This group contains details about the procedure. [<span style=\"font-style:italic\">procedure-details-group-description</span>] (display)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Procedure ID</span> [<span style=\"font-style:italic\">procedure-id</span>] (url)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">NHSN Procedure Code Category</span> [<span style=\"font-style:italic\">nhsn-procedure-code-category</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">CPT Procedure Code</span> [<span style=\"font-style:italic\">cpt-procedure-code</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/ValueSet/cpt-all\">http://hl7.org/fhir/ValueSet/cpt-all</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Procedure duration (in minutes)</span> [<span style=\"font-style:italic\">procedure-duration</span>] (quantity)\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">General anesthesia</span> [<span style=\"font-style:italic\">general-anesthesia</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Surgeon code</span> [<span style=\"font-style:italic\">surgeon-code</span>] (url)\n </li>\n <li>\n <span style=\"font-weight:bold\">Comments</span> [<span style=\"font-style:italic\">nhsn-comment</span>] (text)\n </li>\n </ul>\n </div>"
},
"url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom",
"identifier" : [
{
"value" : "hai-questionnaire-opc-proc-denom-v1"
}
],
"version" : "2.0.0",
"name" : "HAI_questionnaire_opc_proc_denom",
"title" : "Outpatient Procedure Component Denominator for Procedure",
"status" : "draft",
"experimental" : false,
"subjectType" : [
"Patient"
],
"date" : "2019-04-01",
"publisher" : "HL7 Structured Documents Work Group",
"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"
}
]
}
],
"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://hl7.org/fhir/us/hai/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://hl7.org/fhir/us/hai/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://hl7.org/fhir/us/hai/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://www.loinc.org",
"code" : "86468-6",
"display" : "Report Comment Section"
}
],
"text" : "Comments",
"type" : "text",
"required" : false,
"repeats" : false,
"maxLength" : 2000
}
]
}
