This page is part of the Healthcare Associated Infection Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R3. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
JSON Format: QuestionnaireResponse-hai-questionnaireResponse-opc-ssi-event
Raw json
{
"resourceType" : "QuestionnaireResponse",
"id" : "hai-questionnaireResponse-opc-ssi-event",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-14T00:03:04.000-04:00",
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire-response"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <p>This QuestionnaireResponse instance is an example of a completed Outpatient Procedure Component Surgical Site Infection (SSI) Event and is in response to the Questionnaire instance defining this report.</p>\n <h2>Example Outpatient Procedure Component Surgical Site Infection (SSI) Event</h2>\n <h3>Authoring and Facility Information</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Authoring Device</td>\n <td>Id: 2.16.840.1.113883.3.117.1.1.5.1.1.2:anAuthorID</td>\n </tr>\n <tr>\n <td>Facility ID</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W</td>\n </tr>\n <tr>\n <td>Date of encounter</td>\n <td>2018-08-05</td>\n </tr>\n </tbody>\n </table>\n <h3>Patient</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Patient ID</td>\n <td>Medical Record Number: 12345</td>\n </tr>\n <tr>\n <td>Social Security #</td>\n <td>12345</td>\n </tr>\n <tr>\n <td>Medicaid #</td>\n <td>959595</td>\n </tr>\n <tr>\n <td>Patient Last Name</td>\n <td>Nuclear</td>\n </tr>\n <tr>\n <td>Patient First Name</td>\n <td>Ned</td>\n </tr>\n <tr>\n <td>Gender</td>\n <td>Male</td>\n </tr>\n <tr>\n <td>Date of Birth</td>\n <td>1954-11-25</td>\n </tr>\n <tr>\n <td>Ethnicity</td>\n <td>Not Hispanic or Latino</td>\n </tr>\n <tr>\n <td>Race</td>\n <td>White</td>\n </tr>\n </tbody>\n </table>\n <h3>Infection Details</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Event Type</td>\n <td>Surgical Site Infection</td>\n </tr>\n <tr>\n <td>Date of event</td>\n <td>2018-08-06</td>\n </tr>\n <tr>\n <td>NHSN Procedure Code Category</td>\n <td>2108-9: Appendix surgery</td>\n </tr>\n <tr>\n <td>CPT Procedure Code</td>\n <td>44970: Laparoscopic Procedures on the Appendix</td>\n </tr>\n <tr>\n <td>Procedure Id</td>\n <td>urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.5:21987654321</td>\n </tr>\n <tr>\n <td>Surgical Site Infection (SSI) Level</td>\n <td>Superficial incisional primary SSI</td>\n </tr>\n <tr>\n <td>Surveillence method type (active/passive) through which the SSI was detected</td>\n <td>Active SSI Detection Method</td>\n </tr>\n <tr>\n <td>Surveillence method through which the SSI was detected</td>\n <td>Review of patient's medical record</td>\n </tr>\n </tbody>\n </table>\n <h3>Criteria of Diagnosis</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Abscess</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Redness</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Fever</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Heat</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Purulent drainage</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Wound spontaneously dehisced</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Incision deliberately opened</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Localized swelling</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Pain or tenderness</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Organism Identified</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Culture or non-culture based testing not performed</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Imaging test evidence of infection</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Diagnosis of superficial SSI by surgeon or attending physician</td>\n <td>false</td>\n </tr>\n </tbody>\n </table>\n <h3>Findings</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Pathogen Identified</td>\n <td>Staphylococcus, coagulase negative (organism)</td>\n </tr>\n <tr>\n <td>Pathogen Ranking</td>\n <td>First</td>\n </tr>\n <tr>\n <td>Pathogen Identified</td>\n <td>Life form of parasite (organism)</td>\n </tr>\n <tr>\n <td>Pathogen Ranking</td>\n <td>Second</td>\n </tr>\n <tr>\n <td>Pathogen Identified</td>\n <td>Acid-fast bacillus</td>\n </tr>\n <tr>\n <td>Pathogen Ranking</td>\n <td>Third</td>\n </tr>\n </tbody>\n </table>\n <h3>Comment</h3>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>Comment</td>\n <td>NHSN text comment that is less than 2000 characters.</td>\n </tr>\n </tbody>\n </table>\n </div>"
},
"identifier" : {
"system" : "urn:oid:2.16.840.1.113883.3.117.1.1.5.2.1.1.2",
"value" : "20202210"
},
"questionnaire" : {
"reference" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-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-id",
"text" : "Facility ID",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.1.1:9W"
}
]
},
{
"linkId" : "encounter-date",
"text" : "Date of encounter",
"answer" : [
{
"valueDate" : "2018-08-05"
}
]
},
{
"linkId" : "infection-details",
"text" : "Infection details",
"item" : [
{
"linkId" : "event-type",
"text" : "Event Type",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "433202001",
"display" : "Surgical Site Infection"
}
}
]
},
{
"linkId" : "event-date",
"text" : "Date of event",
"answer" : [
{
"valueDate" : "2018-08-06"
}
]
},
{
"linkId" : "nhsn-procedure-code-category",
"text" : "NHSN Procedure Code Category",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "2108-9",
"display" : "Appendix surgery"
}
}
]
},
{
"linkId" : "cpt-procedure-code",
"text" : "CPT Procedure Code",
"answer" : [
{
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "44970",
"display" : "Laparoscopic Procedures on the Appendix"
}
}
]
},
{
"linkId" : "procedure-id",
"text" : "Procedure Id",
"answer" : [
{
"valueUri" : "urn:hl7ii:2.16.840.1.113883.3.117.1.1.5.2.1.1.5:21987654321"
}
]
},
{
"linkId" : "ssi-level",
"text" : "Surgical Site Infection (SSI) Level",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1620-4",
"display" : "Superficial incisional primary SSI"
}
}
]
},
{
"linkId" : "criteria-of-diagnosis",
"text" : "Criteria of Diagnosis",
"item" : [
{
"linkId" : "criteria-of-diagnosis-abscess",
"text" : "Criteria of Diagnosis: Abscess",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-redness",
"text" : "Criteria of Diagnosis: Redness",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-fever",
"text" : "Criteria of Diagnosis: Fever",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-heat",
"text" : "Criteria of Diagnosis: Heat",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "criteria-of-diagnosis-incision-purulent-drainage",
"text" : "Criteria of Diagnosis: Purulent drainage",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "criteria-of-diagnosis-wound-dehisced",
"text" : "Criteria of Diagnosis: Wound spontaneously dehisced",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-incision-opened",
"text" : "Criteria of Diagnosis: Incision deliberately opened",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-evidence-found",
"text" : "Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-localized-swelling",
"text" : "Criteria of Diagnosis: Localized swelling",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-pain-tenderness",
"text" : "Criteria of Diagnosis: Pain or tenderness",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-organism-identified",
"text" : "Criteria of Diagnosis: Organism Identified",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "criteria-of-diagnosis-testing-not-performed",
"text" : "Criteria of Diagnosis: Culture or non-culture based testing not performed",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-imaging-test",
"text" : "Criteria of Diagnosis: Imaging test evidence of infection",
"answer" : [
{
"valueBoolean" : false
}
]
},
{
"linkId" : "criteria-of-diagnosis-physician-diagnosis",
"text" : "Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician",
"answer" : [
{
"valueBoolean" : false
}
]
}
]
},
{
"linkId" : "ssi-detection-method-type",
"text" : "Surveillence method type (active/passive) through which the SSI was detected",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1309-4",
"display" : "Active SSI Detection Method"
}
}
]
},
{
"linkId" : "ssi-detection-method",
"text" : "Surveillence method through which the SSI was detected",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1321-9",
"display" : "Review of patient's medical record"
}
}
]
}
]
},
{
"linkId" : "findings-group",
"text" : "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "116197008",
"display" : "Staphylococcus, coagulase negative (organism)"
}
}
]
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "255216001",
"display" : "First"
}
}
]
}
]
},
{
"linkId" : "findings-group",
"text" : "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "103535006",
"display" : "Life form of parasite (organism)"
}
}
]
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "81170007",
"display" : "Second"
}
}
]
}
]
},
{
"linkId" : "findings-group",
"text" : "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "243365003",
"display" : "Acid-fast bacillus"
}
}
]
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "70905002",
"display" : "Third"
}
}
]
}
]
},
{
"linkId" : "nhsn-comment",
"text" : "Comments",
"answer" : [
{
"valueString" : "NHSN text comment that is less than 2000 characters."
}
]
}
]
}
