| Package | hl7.fhir.us.hai |
| Resource Type | Questionnaire |
| Id | hai-questionnaire-los-denom |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/hai/https://build.fhir.org/ig/HL7/HAI/Questionnaire-hai-questionnaire-los-denom.html |
| URL | http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom |
| Status | active |
| Date | 2019-04-01 |
| Name | HAI_questionnaire_los_denom |
| Title | Late Onset Sepsis/Meningitis Denominator |
| Realm | us |
| Authority | hl7 |
| Description | This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Denominator. This report records the denominator information for neonatal component late onset sepsis and meningitis (LOS/Men). 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/). |
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Note: links and images are rebased to the (stated) source
FHIR{
"resourceType": "Questionnaire",
"id": "hai-questionnaire-los-denom",
"meta": {
"versionId": "10",
"lastUpdated": "2023-02-24T01:35:54.054+00:00",
"source": "#hmWK2y1w5y0ttXcJ",
"profile": [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"
]
},
"language": "en-US",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"url": "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom",
"identifier": [
{
"value": "hai-questionnaire-los-denom-v1"
}
],
"name": "HAI_questionnaire_los_denom",
"title": "Late Onset Sepsis/Meningitis Denominator",
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"date": "2019-04-01",
"publisher": "HL7 International - Structured Documents Work Group",
"contact": [
{
"name": "HL7 International - Structured Documents",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/structure"
}
]
}
],
"description": "This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Denominator. This report records the denominator information for neonatal component late onset sepsis and meningitis (LOS/Men).\n\nFor 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/).\n",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US",
"display": "United States of America"
}
],
"text": "United States of America"
}
],
"code": [
{
"system": "http://loinc.org",
"code": "51897-7",
"display": "Healthcare Associated Infection report Document"
}
],
"item": [
{
"linkId": "date-collected",
"text": "Year and month data collected for this location",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "facility",
"text": "Facility ID",
"type": "url",
"required": true,
"repeats": false
},
{
"linkId": "date-admitted-to-facility",
"text": "Date Admitted to Facility",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "location-within-facility-encounter-group",
"code": [
{
"system": "http://loinc.org",
"code": "46240-8",
"display": "History of Hospitalizations+Outpatient visits Narrative"
}
],
"text": "Location Within Facility Encounter",
"type": "group",
"required": true,
"repeats": false,
"item": [
{
"linkId": "location-within-facility-encounter-group-description",
"text": "This group contains information detailing an encounter at a location within the facility. It contains the patient's location within the facility, the date admitted or transferred to that location, the disposition of the infant and, if the infant was discharged, transferred, or expired, the date on which this occurred is recorded. If the infant had no location change, no date is recorded.",
"type": "display"
},
{
"linkId": "facility-location-type",
"text": "Facility Location Type",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.19"
},
{
"linkId": "facility-location",
"text": "Facility Location",
"type": "url",
"required": true,
"repeats": false
},
{
"linkId": "location-admit-transfer-date",
"text": "Date admitted or transferred to location",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "infant-disposition",
"text": "Disposition of infant",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.10.20.5.9.30"
},
{
"linkId": "disposition-date",
"text": "Disposition date if discharged, transferred, or expired",
"type": "date",
"enableWhen": [
{
"question": "infant-disposition",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "183665006"
}
},
{
"question": "infant-disposition",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "266751003"
}
},
{
"question": "infant-disposition",
"operator": "=",
"answerCoding": {
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"code": "371828006"
}
}
],
"required": false,
"repeats": false
}
]
},
{
"linkId": "risk-factors",
"code": [
{
"system": "http://loinc.org",
"code": "51898-5",
"display": "Risk factors Document"
}
],
"text": "Risk Factors",
"type": "group",
"required": true,
"repeats": false,
"item": [
{
"linkId": "risk-factors-group-description",
"text": "This group contains risk factors such as birth weight and gestational age.",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
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"code": "g",
"display": "g"
}
}
],
"linkId": "risk-factor-birth-weight",
"code": [
{
"system": "http://snomed.info/sct",
"code": "364589006",
"display": "Birth Weight"
}
],
"text": "Risk Factor: Birth weight (grams)",
"type": "quantity",
"required": true,
"repeats": false
},
{
"linkId": "gestational-age-known",
"text": "Gestational age known: set true if known and false if unknown",
"type": "boolean",
"required": true,
"repeats": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "d",
"display": "d"
}
}
],
"linkId": "risk-factor-gestational-age",
"code": [
{
"system": "http://loinc.org",
"code": "76516-4",
"display": "Gestational age--at birth"
}
],
"text": "Risk Factor: Gestational age (days)",
"type": "quantity",
"enableWhen": [
{
"question": "gestational-age-known",
"operator": "=",
"answerBoolean": true
}
],
"required": false,
"repeats": false
}
]
},
{
"linkId": "nhsn-comment",
"code": [
{
"system": "http://loinc.org",
"code": "86468-6",
"display": "Report Comment Section"
}
],
"text": "Comments",
"type": "text",
"required": false,
"repeats": false,
"maxLength": 2000
}
]
}