HealthcareAssociatedInfectionReports Implementation Guide CI Build

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

XML Format: Questionnaire-hai-questionnaire-opc-sdom-event

Raw xml 


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="hai-questionnaire-opc-sdom-event"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" lang="en-US">
         <h1 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Outpatient Procedure Component Same Day Outcome Measures Event Report</h1>
         <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>
         <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>
         <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Details</h2>
         <table xmlns:xsl="http://www.w3.org/1999/XSL/Transform">
            <tr>
               <td>
                  <b>Id:</b>
               </td>
               <td>hai-questionnaire-opc-sdom-event</td>
            </tr>
            <tr>
               <td>
                  <b>Profile:</b>
               </td>
               <td>http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire</td>
            </tr>
            <tr>
               <td>
                  <b>Language:</b>
               </td>
               <td>en-US</td>
            </tr>
            <tr>
               <td>
                  <b>Url:</b>
               </td>
               <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-sdom-event</td>
            </tr>
            <tr>
               <td>
                  <b>Identifier:</b>
               </td>
               <td>
                  <span>hai-questionnaire-opc-sdom-event-v1</span>
               </td>
            </tr>
            <tr>
               <td>
                  <b>Version:</b>
               </td>
               <td>Version: 2.0.0</td>
            </tr>
            <tr>
               <td>
                  <b>Name:</b>
               </td>
               <td>HAI_questionnaire_opc_sdom_event</td>
            </tr>
            <tr>
               <td>
                  <b>Status:</b>
               </td>
               <td>draft</td>
            </tr>
            <tr>
               <td>
                  <b>Experimental:</b>
               </td>
               <td>false</td>
            </tr>
            <tr>
               <td>
                  <b>Subject Type:</b>
               </td>
               <td>Patient (Source Patient Resource (US Core Patient))</td>
            </tr>
            <tr>
               <td>
                  <b>Date:</b>
               </td>
               <td>2019-04-01</td>
            </tr>
            <tr>
               <td>
                  <b>Publisher:</b>
               </td>
               <td>HL7 Structured Documents Work Group</td>
            </tr>
            <tr>
               <td>
                  <b>Jurisdiction:</b>
               </td>
               <td>
                  <span title="Code system: urn:iso:std:iso:3166">Code: US</span>
               </td>
            </tr>
            <tr>
               <td>
                  <b>Code:</b>
               </td>
               <td>
                  <ul style="list-style:none; padding-left:0; margin:0 0;">
                     <li>Healthcare Associated Infection report Document</li>
                     <li>Code system: <a href="http://loinc.org">http://loinc.org</a>
                     </li>
                     <li>Code: 51897-7</li>
                  </ul>
               </td>
            </tr>
         </table>
         <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/>
         <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/>
         <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Items (<span style="color:red">*</span> required)</h2>
         <ul xmlns:xsl="http://www.w3.org/1999/XSL/Transform" style="list-style:none;">
            <li>
               <span style="color:red">* </span>
               <span style="font-weight:bold">Facility ID</span> [<span style="font-style:italic">facility-id</span>] (url)
    </li>
            <li>
               <span style="color:red">* </span>
               <span style="font-weight:bold">Date of Encounter (Admission)</span> [<span style="font-style:italic">date-of-encounter</span>] (date)
    </li>
            <li>
               <span style="color:red">* </span>
               <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)
    <ul style="list-style:none;">
                  <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
                  <li>
                     <span style="color:red">* </span>
                     <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)
    </li>
               </ul>
            </li>
            <li>
               <span style="font-weight:bold">Comments</span> [<span style="font-style:italic">nhsn-comment</span>] (text)
    </li>
         </ul>
      </div>
  </text>
  <url
       value="http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-sdom-event"/>
  <identifier>
    <value value="hai-questionnaire-opc-sdom-event-v1"/>
  </identifier>
  <version value="2.0.0"/>
  <name value="HAI_questionnaire_opc_sdom_event"/>
  <title
         value="Outpatient Procedure Component Same Day Outcome Measures Event Report"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2019-04-01"/>
  <publisher value="HL7 Structured Documents Work Group"/>
  <description
               value="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.

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/](https://www.cdc.gov/nhsn/).
"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <code>
    <system value="http://loinc.org"/>
    <code value="51897-7"/>
    <display value="Healthcare Associated Infection report Document"/>
  </code>
  <item>
    <linkId value="facility-id"/>
    <text value="Facility ID"/>
    <type value="url"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="date-of-encounter"/>
    <text value="Date of Encounter (Admission)"/>
    <type value="date"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="same-day-outcome-measures-event-details"/>
    <code>
      <system value="http://loinc.org"/>
      <code value="51899-3"/>
      <display value="Details Document"/>
    </code>
    <text value="Same Day Outcome Measures Event Details"/>
    <type value="group"/>
    <required value="true"/>
    <repeats value="false"/>
    <item>
      <linkId value="same-day-outcome-measures-event-details-group-description"/>
      <text
            value="This group contains details about same-day outcome measures events."/>
      <type value="display"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-patient-burn"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="125666000"/>
        <display value="Burn"/>
      </code>
      <text value="Same Day Outcome Measure: Patient Burn"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-patient-fall"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="217082002"/>
        <display value="Accidental fall"/>
      </code>
      <text value="Same Day Outcome Measure: Patient fall"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-transfer-admission"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1645-1"/>
        <display value="Hospital transer/admission"/>
      </code>
      <text value="Same Day Outcome Measure: Hospital transfer/admission"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-site"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1646-9"/>
        <display value="Wrong site"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong site"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-side"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1647-7"/>
        <display value="Wrong side"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong side"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-patient"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1648-5"/>
        <display value="Wrong patient"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong patient"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-procedure"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="370898007"/>
        <display value="Wrong surgical procedure performed on a patient"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong procedure"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="same-day-outcome-measure-wrong-implant"/>
      <code>
        <system
                value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/>
        <code value="1649-3"/>
        <display value="Wrong implant"/>
      </code>
      <text value="Same Day Outcome Measure: Wrong implant"/>
      <type value="boolean"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
  </item>
  <item>
    <linkId value="nhsn-comment"/>
    <code>
      <system value="http://www.loinc.org"/>
      <code value="86468-6"/>
      <display value="Report Comment Section"/>
    </code>
    <text value="Comments"/>
    <type value="text"/>
    <required value="false"/>
    <repeats value="false"/>
    <maxLength value="2000"/>
  </item>
</Questionnaire>