This page is part of the Healthcare Associated Infection Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR v3.3.0. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
This QuestionnaireResponse instance is an example of a completed Late Onset Sepsis/Meningitis Event (LOS) Report and is in response to the Questionnaire instance defining this report.
Patient Details
Name |
Ned Nuclear
|
Id |
MRN: 12345 |
Medicaid beneficiary number |
959595 |
Event Details
Infection Type |
Late onset sepsis |
Specific Event |
NLCBI 2 |
Criteria used |
Recognized pathogen from one or more blood specimens |
Date of Infection |
January 2, 2018 |
Inborn/Outborn |
Inborn |
Dead |
Yes |
Infection Contributed to Death |
No |
Risk Factors
Central line present prior to event, including umbilical catheter |
Yes |
Birth Weight |
700 g |
Gestational Age |
276 d |
Findings
Microorganism
identified |
Clostridium symbiosum (organism) |
Pathogen Ranking |
1 |
Clarithro Susc Islt |
Not Applicable Resistant |
Comment
Comment |
NHSN text comment that is less than 2000 characters. |