| Package | hl7.fhir.us.hai |
| Resource Type | Questionnaire |
| Id | hai-questionnaire-los-event |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/hai/https://build.fhir.org/ig/HL7/HAI/Questionnaire-hai-questionnaire-los-event.html |
| URL | http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-event |
| Status | active |
| Date | 2019-04-01 |
| Name | HAI_questionnaire_los_event |
| Title | Late Onset Sepsis/Meningitis Event (LOS) |
| Realm | us |
| Authority | hl7 |
| Description | This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Report. It records a late onset sepsis/meningitis infection event. For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present. 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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FHIR{
"resourceType": "Questionnaire",
"id": "hai-questionnaire-los-event",
"meta": {
"versionId": "13",
"lastUpdated": "2023-02-24T01:35:54.069+00:00",
"source": "#TutCpWfFornPy4FG",
"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-event",
"identifier": [
{
"value": "hai-questionnaire-los-event-v2"
}
],
"name": "HAI_questionnaire_los_event",
"title": "Late Onset Sepsis/Meningitis Event (LOS)",
"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) Report. It records a late onset sepsis/meningitis infection event. For Late Onset Sepsis/Meningitis Event Reports, a Medicaid beneficiary number may be present.\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": "facility",
"text": "Facility ID",
"type": "url",
"required": true,
"repeats": false
},
{
"linkId": "event-number",
"text": "Event Number",
"type": "url",
"required": false,
"repeats": false
},
{
"linkId": "event-type",
"text": "Event Type",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.20"
},
{
"linkId": "date-of-event",
"text": "Date of Event",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "facility-location",
"text": "Facility Location",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.19"
},
{
"linkId": "date-admitted-to-facility",
"text": "Date Admitted to Facility:",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "inborn-outborn-observation",
"code": [
{
"system": "http://snomed.info/sct",
"code": "445087001",
"display": "Born before arrival to hospital (situation)"
}
],
"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.",
"type": "boolean",
"required": true,
"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",
"text": "This group contains risk factors such as central line present, birth weight, and gestational age.",
"type": "display"
},
{
"linkId": "risk-factor-central-line",
"code": [
{
"system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
"code": "1006-6",
"display": "central line including umbilical catheter"
}
],
"text": "Risk Factor: Central line present prior to event, including umbilical catheter",
"type": "boolean",
"required": false,
"repeats": false
},
{
"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": "event-details",
"code": [
{
"system": "http://loinc.org",
"code": "51899-3",
"display": "Details Document"
}
],
"text": "Event Details",
"type": "group",
"required": true,
"repeats": false,
"item": [
{
"linkId": "event-details-group",
"text": "This group contains details aboout the late onset septis infection event.",
"type": "display"
},
{
"linkId": "infection-condition",
"text": "Specific Event",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3196"
},
{
"linkId": "criteria-used",
"text": "Laboratory Criteria Used",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3195"
},
{
"linkId": "died",
"code": [
{
"system": "http://snomed.info/sct",
"code": "419099009",
"display": "dead"
}
],
"text": "Died",
"type": "boolean",
"required": true,
"repeats": false
},
{
"linkId": "los-contributed-to-death",
"text": "Infection contributed to death",
"type": "boolean",
"enableWhen": [
{
"question": "died",
"operator": "=",
"answerBoolean": true
}
],
"required": false,
"repeats": false
},
{
"linkId": "discharge-date",
"text": "Discharge Date",
"type": "date",
"required": false,
"repeats": false
}
]
},
{
"linkId": "findings-group",
"code": [
{
"system": "http://loinc.org",
"code": "18769-0",
"display": "Microbial susceptibility tests Set"
}
],
"text": "Findings Group",
"type": "group",
"required": true,
"repeats": true,
"item": [
{
"linkId": "findings-group-description",
"text": "This group records whether infection organisms were identified and, if so, records details about them.",
"type": "display"
},
{
"linkId": "pathogen-identified",
"text": "Pathogen Identified",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.16"
},
{
"linkId": "pathogen-ranking",
"text": "Pathogen Ranking",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking"
},
{
"linkId": "drug-susceptibility-test-group",
"text": "Drug Susceptibility Test Group",
"type": "group",
"repeats": true,
"item": [
{
"linkId": "drug-susceptibility-test-group-description",
"text": "This group contains drug-susceptibility information such as the drug and the pathogen's susceptibility to it.",
"type": "display"
},
{
"linkId": "drug-susceptibility-test",
"text": "Drug Susceptibility Test",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.15"
},
{
"linkId": "drug-susceptibility-test-interpretation",
"text": "Drug Susceptibility Test Interpretation",
"type": "choice",
"required": false,
"repeats": false,
"answerValueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.13.13"
}
]
}
]
},
{
"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
}
]
}