# Additional Supplemental Data Example - Data Exchange For Quality Measures Implementation Guide v1.0.0-ballot

## Example MeasureReport: Additional Supplemental Data Example



## Resource Content

```json
{
  "resourceType" : "MeasureReport",
  "id" : "sde-example",
  "language" : "en",
  "contained" : [{
    "resourceType" : "Patient",
    "id" : "nhsn-iip-ip101",
    "text" : {
      "status" : "generated",
      "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table class=\"hapiPropertyTable\"><tbody><tr><td>Identifier</td><td>nhsn-iip-ip101</td></tr><tr><td>Date of birth</td><td><span>19 February 1987</span></td></tr></tbody></table></div>"
    },
    "extension" : [{
      "extension" : [{
        "url" : "ombCategory",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2106-3",
          "display" : "White"
        }
      },
      {
        "url" : "ombCategory",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "1002-5",
          "display" : "American Indian or Alaska Native"
        }
      },
      {
        "url" : "ombCategory",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2028-9",
          "display" : "Asian"
        }
      },
      {
        "url" : "detailed",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "1586-7",
          "display" : "Shoshone"
        }
      },
      {
        "url" : "detailed",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2036-2",
          "display" : "Filipino"
        }
      },
      {
        "url" : "text",
        "valueString" : "Mixed"
      }],
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
    },
    {
      "extension" : [{
        "url" : "ombCategory",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2135-2",
          "display" : "Hispanic or Latino"
        }
      },
      {
        "url" : "detailed",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2184-0",
          "display" : "Dominican"
        }
      },
      {
        "url" : "detailed",
        "valueCoding" : {
          "system" : "urn:oid:2.16.840.1.113883.6.238",
          "code" : "2148-5",
          "display" : "Mexican"
        }
      },
      {
        "url" : "text",
        "valueString" : "Hispanic or Latino"
      }],
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
    }],
    "identifier" : [{
      "system" : "http://example.org",
      "value" : "nhsn-iip-ip101"
    }],
    "gender" : "female",
    "birthDate" : "1987-02-19"
  },
  {
    "resourceType" : "MedicationRequest",
    "id" : "nhsn-iip-add101",
    "status" : "completed",
    "intent" : "original-order",
    "medicationCodeableConcept" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "1161609",
        "display" : "metFORMIN Oral Liquid Product"
      }],
      "text" : "metFORMIN Oral Liquid Product"
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    }
  },
  {
    "resourceType" : "MedicationRequest",
    "id" : "nhsn-iip-add101-10",
    "status" : "active",
    "intent" : "order",
    "medicationCodeableConcept" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "1161609",
        "display" : "metFORMIN Oral Liquid Product"
      }],
      "text" : "metFORMIN Oral Liquid Product"
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "dosageInstruction" : [{
      "timing" : {
        "repeat" : {
          "boundsPeriod" : {
            "start" : "2021-02-15T16:43:55Z",
            "end" : "2021-02-22T21:32:24Z"
          },
          "frequency" : 1,
          "period" : 1,
          "periodUnit" : "d"
        },
        "code" : {
          "text" : "PRN"
        }
      },
      "asNeededBoolean" : true,
      "route" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "78421000",
          "display" : "Intramuscular use"
        }],
        "text" : "Intramuscular use"
      },
      "doseAndRate" : [{
        "type" : {
          "coding" : [{
            "system" : "http://example.org/CodeSystem/dose-rate-type",
            "code" : "calculated",
            "display" : "calculated"
          }],
          "text" : "calculated"
        },
        "doseQuantity" : {
          "value" : 1,
          "unit" : "mg",
          "system" : "http://unitsofmeasure.org",
          "code" : "mg"
        }
      },
      {
        "type" : {
          "coding" : [{
            "system" : "http://example.org/CodeSystem/dose-rate-type",
            "code" : "admin-amount",
            "display" : "admin-amount"
          }],
          "text" : "admin-amount"
        },
        "doseQuantity" : {
          "value" : 1,
          "unit" : "mL",
          "system" : "http://unitsofmeasure.org",
          "code" : "mL"
        }
      },
      {
        "type" : {
          "coding" : [{
            "system" : "http://example.org/CodeSystem/dose-rate-type",
            "code" : "ordered",
            "display" : "ordered"
          }],
          "text" : "ordered"
        },
        "doseQuantity" : {
          "value" : 1,
          "unit" : "mg",
          "system" : "http://unitsofmeasure.org",
          "code" : "mg"
        }
      }]
    }]
  },
  {
    "resourceType" : "Observation",
    "id" : "791eebdb-ee7d-464f-bd21-12fe2b4c0dd3",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2148-5"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "0ce0a9f1-f5a3-42ca-81a6-69c08ee9f79c",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2135-2"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "5d85b278-443a-4a0f-9778-bdac6223f8fd",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2184-0"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "57f8ba34-88c0-4152-8a8c-74aa2a508353",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }]
  },
  {
    "resourceType" : "Observation",
    "id" : "16f76e4f-86de-4ff1-b54c-19507069044b",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "1002-5"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "a6d7e84c-7ae0-41e1-9ba3-bb86cf48c7c8",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2036-2"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "bd705f82-80d1-4a50-8dec-686f5f0a02bd",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "1586-7"
      }]
    }
  },
  {
    "resourceType" : "Observation",
    "id" : "8c9e0819-2eb4-470b-abbb-ac4fa4b707b1",
    "extension" : [{
      "extension" : [{
        "url" : "measure",
        "valueCanonical" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo"
    }],
    "status" : "final",
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    },
    "subject" : {
      "reference" : "Patient/nhsn-iip-ip101"
    },
    "effectivePeriod" : {
      "start" : "2022-01-01T09:30:10+01:00"
    },
    "performer" : [{
      "reference" : "Organization/organization01"
    }],
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2028-9"
      }]
    }
  }],
  "extension" : [{
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-chief-complaint"
      },
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-encounter-discharge-dispositions"
      }],
      "reference" : "Encounter/nhsn-iip-en101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-condition"
      },
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-condition-during-encounter"
      }],
      "reference" : "Condition/nhsn-iip-con101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-encounter-locations"
      }],
      "reference" : "Encounter/nhsn-iip-en101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-medication-request"
      }],
      "reference" : "MedicationRequest/nhsn-iip-add101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-medication-request"
      }],
      "reference" : "MedicationRequest/nhsn-iip-add101-10"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-minimal-patient"
      }],
      "reference" : "#nhsn-iip-ip101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-minimal-medication-requests"
      }],
      "reference" : "#nhsn-iip-add101"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-minimal-medication-requests"
      }],
      "reference" : "#nhsn-iip-add101-10"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-ethnicity-coding"
      }],
      "reference" : "#791eebdb-ee7d-464f-bd21-12fe2b4c0dd3"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-ethnicity-coding"
      }],
      "reference" : "#0ce0a9f1-f5a3-42ca-81a6-69c08ee9f79c"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-ethnicity-coding"
      }],
      "reference" : "#5d85b278-443a-4a0f-9778-bdac6223f8fd"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-race-coding"
      }],
      "reference" : "#57f8ba34-88c0-4152-8a8c-74aa2a508353"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-race-coding"
      }],
      "reference" : "#16f76e4f-86de-4ff1-b54c-19507069044b"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-race-coding"
      }],
      "reference" : "#a6d7e84c-7ae0-41e1-9ba3-bb86cf48c7c8"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-race-coding"
      }],
      "reference" : "#bd705f82-80d1-4a50-8dec-686f5f0a02bd"
    }
  },
  {
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData",
    "valueReference" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
        "valueString" : "sde-race-coding"
      }],
      "reference" : "#8c9e0819-2eb4-470b-abbb-ac4fa4b707b1"
    }
  }],
  "status" : "complete",
  "type" : "individual",
  "measure" : "http://nhsnlink.org/fhir/Measure/NHSNGlycemicControlHypoglycemicInitialPopulation",
  "subject" : {
    "reference" : "Patient/nhsn-iip-ip101"
  },
  "date" : "2022-10-24T11:36:58-06:00",
  "period" : {
    "start" : "2022-01-01T00:00:00-07:00",
    "end" : "2022-01-31T23:59:59-07:00"
  },
  "group" : [{
    "population" : [{
      "id" : "initial-population-01",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "count" : 1
    }]
  }],
  "evaluatedResource" : [{
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
      "valueString" : "initial-population-01"
    }],
    "reference" : "Location/nhsn-iip-loc101"
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
      "valueString" : "initial-population-01"
    }],
    "reference" : "MedicationRequest/nhsn-iip-add101"
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
      "valueString" : "initial-population-01"
    }],
    "reference" : "Encounter/nhsn-iip-en101"
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
      "valueString" : "initial-population-01"
    }],
    "reference" : "MedicationRequest/nhsn-iip-add101-10"
  }]
}

```
