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: QuestionnaireResponse-hai-questionnaireresponse-los-event
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireresponse-los-event",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaireresponse"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <table xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\" class=\"bare\">\n <tr>\n <td>\n <b>Id:</b>\n </td>\n <td>hai-questionnaireresponse-los-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-questionnaireresponse</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>Identifier:</b>\n </td>\n <td>\n <span title=\"Code system: urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.2\">20202202</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Questionnaire:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event</td>\n </tr>\n <tr>\n <td>\n <b>Status:</b>\n </td>\n <td>completed</td>\n </tr>\n <tr>\n <td>\n <b>Subject:</b>\n </td>\n <td>\n <a href=\"Patient-hai-patient-1.html\">hai-patient-1</a>\n </td>\n </tr>\n <tr>\n <td>\n <b>Author:</b>\n </td>\n <td>\n <a href=\"Device-hai-authoring-device.html\">hai-authoring-device</a>\n </td>\n </tr>\n </table>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">QuestionnaireResponse Answers</h2>\n <ul xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\" style=\"list-style:none;\">\n <li>\n <span style=\"font-weight:bold\">Facility ID</span> [<span style=\"font-style:italic\">facility</span>]: \n <span style=\"text-decoration:underline\">urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Event Number</span> [<span style=\"font-style:italic\">event-number</span>]: \n <span style=\"text-decoration:underline\">urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Event Type</span> [<span style=\"font-style:italic\">event-type</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Late-onset neonatal sepsis (disorder)</li>\n <li>Code system: <a href=\"http://snomed.info/sct\">http://snomed.info/sct</a>\n </li>\n <li>Code: 765107002</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Date of Event</span> [<span style=\"font-style:italic\">date-of-event</span>]: \n <span style=\"text-decoration:underline\">2018-01-02</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Facility Location</span> [<span style=\"font-style:italic\">facility-location</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Medical/Surgical Critical Care</li>\n <li>Code system: <a href=\"http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259\">http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259</a>\n </li>\n <li>Code: 1029-8</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Date Admitted to Facility:</span> [<span style=\"font-style:italic\">date-admitted-to-facility</span>]: \n <span style=\"text-decoration:underline\">2018-01-01</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">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.</span> [<span style=\"font-style:italic\">inborn-outborn-observation</span>]: \n <span style=\"text-decoration:underline\">false</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Risk Factors</span> [<span style=\"font-style:italic\">risk-factors</span>]: \n <ul style=\"list-style:none;\">\n <li>\n <span style=\"font-weight:bold\">Risk Factor: Central line present prior to event, including umbilical catheter</span> [<span style=\"font-style:italic\">risk-factor-central-line</span>]: \n <span style=\"text-decoration:underline\">true</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Risk Factor: Birth weight (grams)</span> [<span style=\"font-style:italic\">risk-factor-birth-weight</span>]: \n <span style=\"text-decoration:underline\">700g</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Gestational age known: set true if known and false if unknown</span> [<span style=\"font-style:italic\">gestational-age-known</span>]: \n <span style=\"text-decoration:underline\">true</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Risk Factor: Gestational age (days)</span> [<span style=\"font-style:italic\">risk-factor-gestational-age</span>]: \n <span style=\"text-decoration:underline\">276d</span>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Event Details</span> [<span style=\"font-style:italic\">event-details</span>]: \n <ul style=\"list-style:none;\">\n <li>\n <span style=\"font-weight:bold\">Specific Event</span> [<span style=\"font-style:italic\">infection-condition</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)</li>\n <li>Code system: <a href=\"http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277\">http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277</a>\n </li>\n <li>Code: 3067-6</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Laboratory Criteria Used</span> [<span style=\"font-style:italic\">criteria-used</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Recognized pathogen from one or more blood cultures</li>\n <li>Code system: <a href=\"http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277\">http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277</a>\n </li>\n <li>Code: 1951-3</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Died</span> [<span style=\"font-style:italic\">died</span>]: \n <span style=\"text-decoration:underline\">true</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Infection contributed to death</span> [<span style=\"font-style:italic\">los-contributed-to-death</span>]: \n <span style=\"text-decoration:underline\">false</span>\n </li>\n <li>\n <span style=\"font-weight:bold\">Discharge Date</span> [<span style=\"font-style:italic\">discharge-date</span>]: \n <span style=\"text-decoration:underline\">2018-01-12</span>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Findings Group</span> [<span style=\"font-style:italic\">findings-group</span>]: \n <ul style=\"list-style:none;\">\n <li>\n <span style=\"font-weight:bold\">Pathogen Identified</span> [<span style=\"font-style:italic\">pathogen-identified</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Clostridium symbiosum (organism)</li>\n <li>Code system: <a href=\"http://snomed.info/sct\">http://snomed.info/sct</a>\n </li>\n <li>Code: 48321006</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Pathogen Ranking</span> [<span style=\"font-style:italic\">pathogen-ranking</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>First</li>\n <li>Code system: <a href=\"http://snomed.info/sct\">http://snomed.info/sct</a>\n </li>\n <li>Code: 255216001</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Drug Susceptibility Test Group</span> [<span style=\"font-style:italic\">drug-susceptibility-test-group</span>]: \n <ul style=\"list-style:none;\">\n <li>\n <span style=\"font-weight:bold\">Drug Susceptibility Test</span> [<span style=\"font-style:italic\">drug-susceptibility-test</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Clarithro Susc Islt</li>\n <li>Code system: <a href=\"http://loinc.org\">http://loinc.org</a>\n </li>\n <li>Code: 18907-6</li>\n </span>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Drug Susceptibility Test Interpretation</span> [<span style=\"font-style:italic\">drug-susceptibility-test-interpretation</span>]: \n <ul>\n <span style=\"text-decoration:underline\">\n <li>Resistant</li>\n <li>Code system: <a href=\"http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation\">http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation</a>\n </li>\n <li>Code: R</li>\n </span>\n </ul>\n </li>\n </ul>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Comments</span> [<span style=\"font-style:italic\">nhsn-comment</span>]: \n <span style=\"text-decoration:underline\">NHSN text comment that is less than 2000 characters.</span>\n </li>\n </ul>\n </div>"
},
"identifier" : {
"system" : "urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.2",
"value" : "20202202"
},
"questionnaire" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event",
"status" : "completed",
"subject" : {
"reference" : "Patient/hai-patient-1",
"display" : "hai-patient-1"
},
"author" : {
"reference" : "Device/hai-authoring-device",
"display" : "hai-authoring-device"
},
"item" : [
{
"linkId" : "facility",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W"
}
]
},
{
"linkId" : "event-number",
"text" : "Event Number",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.3:31"
}
]
},
{
"linkId" : "event-type",
"text" : "Event Type",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "765107002",
"display" : "Late-onset neonatal sepsis (disorder)"
}
}
]
},
{
"linkId" : "date-of-event",
"text" : "Date of Event",
"answer" : [
{
"valueDate" : "2018-01-02"
}
]
},
{
"linkId" : "facility-location",
"text" : "Facility Location",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.259",
"code" : "1029-8",
"display" : "Medical/Surgical Critical Care"
}
}
]
},
{
"linkId" : "date-admitted-to-facility",
"text" : "Date Admitted to Facility:",
"answer" : [
{
"valueDate" : "2018-01-01"
}
]
},
{
"linkId" : "inborn-outborn-observation",
"text" : "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.",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "risk-factors",
"text" : "Risk Factors",
"item" : [
{
"linkId" : "risk-factor-central-line",
"text" : "Risk Factor: Central line present prior to event, including umbilical catheter",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "risk-factor-birth-weight",
"text" : "Risk Factor: Birth weight (grams)",
"answer" : [
{
"valueQuantity" : {
"value" : 700,
"unit" : "g"
}
}
]
},
{
"linkId" : "gestational-age-known",
"text" : "Gestational age known: set true if known and false if unknown",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "risk-factor-gestational-age",
"text" : "Risk Factor: Gestational age (days)",
"answer" : [
{
"valueQuantity" : {
"value" : 276,
"unit" : "d"
}
}
]
}
]
},
{
"linkId" : "event-details",
"text" : "Event Details",
"item" : [
{
"linkId" : "infection-condition",
"text" : "Specific Event",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "3067-6",
"display" : "Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)"
}
}
]
},
{
"linkId" : "criteria-used",
"text" : "Laboratory Criteria Used",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1951-3",
"display" : "Recognized pathogen from one or more blood cultures"
}
}
]
},
{
"linkId" : "died",
"text" : "Died",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "los-contributed-to-death",
"text" : "Infection contributed to death",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "discharge-date",
"text" : "Discharge Date",
"answer" : [
{
"valueDate" : "2018-01-12"
}
]
}
]
},
{
"linkId" : "findings-group",
"text" : "Findings Group",
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "48321006",
"display" : "Clostridium symbiosum (organism)"
}
}
]
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "255216001",
"display" : "First"
}
}
]
},
{
"linkId" : "drug-susceptibility-test-group",
"text" : "Drug Susceptibility Test Group",
"item" : [
{
"linkId" : "drug-susceptibility-test",
"text" : "Drug Susceptibility Test",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "18907-6",
"display" : "Clarithro Susc Islt"
}
}
]
},
{
"linkId" : "drug-susceptibility-test-interpretation",
"text" : "Drug Susceptibility Test Interpretation",
"answer" : [
{
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code" : "R",
"display" : "Resistant"
}
}
]
}
]
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
