NHSN Healthcare Associated Infection (HAI) Reports
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NHSN Healthcare Associated Infection (HAI) Reports, published by HL7 International - Structured Documents Work Group. This is not an authorized publication; it is the continuous build for version 2.1.0). This version is based on the current content of https://github.com/HL7/HAI/ and changes regularly. See the Directory of published versions

: Questionnaire - Late Onset Sepsis/Meningitis Event (LOS) - JSON Representation

Active as of 2019-04-01

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{
  "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Placeholder</div>"
  },
  "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
    }
  ]
}