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-sdom-event
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-questionnaire-opc-sdom-event",
"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 Same Day Outcome Measures Event Report</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 Same Day Outcome Measures Event Report. It records data on each patient who experienced one or more of the same day outcome measures events.</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-sdom-event</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-sdom-event</td>\n </tr>\n <tr>\n <td>\n <b>Identifier:</b>\n </td>\n <td>\n <span>hai-questionnaire-opc-sdom-event-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_sdom_event</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 (Admission)</span> [<span style=\"font-style:italic\">date-of-encounter</span>] (date)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measures Event Details</span> [<span style=\"font-style:italic\">same-day-outcome-measures-event-details</span>] (group)\n <ul style=\"list-style:none;\">\n <li>This group contains details about same-day outcome measures events. [<span style=\"font-style:italic\">same-day-outcome-measures-event-details-group-description</span>] (display)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Patient Burn</span> [<span style=\"font-style:italic\">same-day-outcome-measure-patient-burn</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Patient fall</span> [<span style=\"font-style:italic\">same-day-outcome-measure-patient-fall</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Hospital transfer/admission</span> [<span style=\"font-style:italic\">same-day-outcome-transfer-admission</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Wrong site</span> [<span style=\"font-style:italic\">same-day-outcome-measure-wrong-site</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Wrong side</span> [<span style=\"font-style:italic\">same-day-outcome-measure-wrong-side</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Wrong patient</span> [<span style=\"font-style:italic\">same-day-outcome-measure-wrong-patient</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Wrong procedure</span> [<span style=\"font-style:italic\">same-day-outcome-measure-wrong-procedure</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Same Day Outcome Measure: Wrong implant</span> [<span style=\"font-style:italic\">same-day-outcome-measure-wrong-implant</span>] (boolean)\n </li>\n </ul>\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-sdom-event",
"identifier" : [
{
"value" : "hai-questionnaire-opc-sdom-event-v1"
}
],
"version" : "2.0.0",
"name" : "HAI_questionnaire_opc_sdom_event",
"title" : "Outpatient Procedure Component Same Day Outcome Measures Event Report",
"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 Same Day Outcome Measures Event Report. It records data on each patient who experienced one or more of the same day outcome measures events.\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" : "date-of-encounter",
"text" : "Date of Encounter (Admission)",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measures-event-details",
"code" : [
{
"system" : "http://loinc.org",
"code" : "51899-3",
"display" : "Details Document"
}
],
"text" : "Same Day Outcome Measures Event Details",
"type" : "group",
"required" : true,
"repeats" : false,
"item" : [
{
"linkId" : "same-day-outcome-measures-event-details-group-description",
"text" : "This group contains details about same-day outcome measures events.",
"type" : "display"
},
{
"linkId" : "same-day-outcome-measure-patient-burn",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "125666000",
"display" : "Burn"
}
],
"text" : "Same Day Outcome Measure: Patient Burn",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-patient-fall",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "217082002",
"display" : "Accidental fall"
}
],
"text" : "Same Day Outcome Measure: Patient fall",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-transfer-admission",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1645-1",
"display" : "Hospital transer/admission"
}
],
"text" : "Same Day Outcome Measure: Hospital transfer/admission",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-site",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1646-9",
"display" : "Wrong site"
}
],
"text" : "Same Day Outcome Measure: Wrong site",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-side",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1647-7",
"display" : "Wrong side"
}
],
"text" : "Same Day Outcome Measure: Wrong side",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-patient",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1648-5",
"display" : "Wrong patient"
}
],
"text" : "Same Day Outcome Measure: Wrong patient",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-procedure",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "370898007",
"display" : "Wrong surgical procedure performed on a patient"
}
],
"text" : "Same Day Outcome Measure: Wrong procedure",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "same-day-outcome-measure-wrong-implant",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1649-3",
"display" : "Wrong implant"
}
],
"text" : "Same Day Outcome Measure: Wrong implant",
"type" : "boolean",
"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
}
]
}
