Respiratory Virus Hospitalization Surveillance Network (RESP-NET) Content Implementation Guide
1.0.0 - STU 1
Respiratory Virus Hospitalization Surveillance Network (RESP-NET) Content Implementation Guide
1.0.0 - STU 1
Respiratory Virus Hospitalization Surveillance Network (RESP-NET) Content Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-resp-net-ig/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
This section provides an overview of the RESP-NET use case data elements (as depicted on case report forms (CRF)) and their mappings to HL7 FHIR resources, profiles, and elements.
Hospital-based Influenza Case Detection: This use case includes a minimum set of data elements which include: data elements to define the catchment area, patient age or date of birth, sex, race/ethnicity, hospital admission date, hospital facility name, positive influenza testing data (test type, test result, test date), and influenza type and subtype (if available).
| A | B | C | |
|---|---|---|---|
|
1
|
Use Case 1 CRF Data Element | Mapping Fidelity | RESP-NET on FHIR IG Profile Mapping |
|
2
|
State | Complete | us-ph-patient.address.state |
|
3
|
County | Complete | us-ph-patient.address.district |
|
4
|
Patient age | Indirect | calculated by subtracting us-ph-patient.birthdate from us-public-health-encounter.period.start |
|
5
|
Date of birth | Complete | us-ph-patient.birthdate |
|
6
|
Sex | Complete | us-ph-patient.birthsex |
|
7
|
Race | Partial | us-ph-patient.extension:race |
|
8
|
White | Complete | us-ph-patient.extension:race(White) |
|
9
|
Black or African American | Complete | us-ph-patient.extension:race(Black or African American) |
|
10
|
Asian | Complete | us-ph-patient.extension:race(Asian) |
|
11
|
Native Hawaiian or Other Pacific Islander | Complete | us-ph-patient.extension:race(Native Hawaiian or Other Pacific Islander) |
|
12
|
American Indian or Alaska Native | Complete | us-ph-patient.extension:race(American Indian or Alaska Native) |
|
13
|
Multiracial, not otherwise specified | Gap | |
|
14
|
Not specified | Complete | us-ph-patient.extension:race(Unknown) |
|
15
|
Ethnicity | Partial | us-ph-patient.extension:ethnicity |
|
16
|
Hispanic or Latino | Complete | us-ph-patient.extension:ethnicity(Hispanic or Latino) |
|
17
|
Non-Hispanic/Latino | Complete | us-ph-patient.extension:ethnicity(Non Hispanic or Latino) |
|
18
|
Not Specified | Gap | |
|
19
|
Hospital admission date | Indirect | us-ph-encounter.period.start AND us-ph-encounter.period.end |
|
20
|
Positive influenza testing data, TstTyp1, TstTyp2, TstTyp3, TstTyp4 | Indirect | us-ph-lab-result-observation.code |
|
21
|
Positive influenza testing data, TstRes1, TstRes2, TstRes3, TstRes4 | Indirect | us-ph-lab-result-observation.value |
|
22
|
Positive influenza testing data TstResOth1, TstResOth2, TstResOth3, TstResOth4 | Indirect | us-ph-lab-result-observation.value |
|
23
|
Positive influenza testing data PosTstDt1, PosTstDt2, PosTstDt3, PosTstDt4 | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
24
|
Positive influenza testing data, HospLab1, HospLab2, HospLab3, HospLab4 | Indirect | us-ph-lab-result-observation.performer.organization.identifier |
|
25
|
Positive influenza testing data HospLab1Oth, HospLab2Oth, HospLab3Oth, HospLab4Oth | Indirect | us-ph-lab-result-observation.performer.organization.identifier |
|
26
|
Positive influenza testing data SpecID1, SpecID2, SpecID3, SpecID4 | Indirect | us-ph-lab-result-observation.specimen.accessionIdentifier |
|
27
|
ICU admission | Indirect | us-ph-encounter.serviceType = intensive care medicine OR pediatric intensive care medicine |
|
28
|
Mechanical ventilation | Indirect | eicr-procedure.code |
|
29
|
Outcome: Alive | Gap | |
|
30
|
Outcome: Died during hospitalization | Indirect | us-ph-patient.deceasedDateTime OR us-ph-encounter.dischargeDisposition(Expired) |
|
31
|
Outcome: Unknown | Gap | |
|
32
|
Length of Stay/Discharge Date | Indirect | us-ph-encounter.period.end |
Hospital-based Clinical Influenza Surveillance: This use case focuses on the more detailed clinical surveillance data collected in FluSurv-NET by site surveillance officers. Patient-level data from EHRs about persons hospitalized with influenza include data on important outcomes and indicators of disease severity such as ICU admission, mechanical ventilation, in-hospital death, and length of hospital stay. Additional elements include health history (underlying conditions, tobacco, alcohol, substance use), clinical course, viral and bacterial codetections, findings from chest imaging, diagnoses, vaccination, and treatment. This use case will include person-level clinical data elements that are currently collected in FluSurv-NET on a standardized case report form for all identified cases. Not all of the current data elements may be reachable in a FHIR-based approach; proposed solutions should recognize that this may evolve over time and surveillance officers may still need to conduct medical chart review on data elements.
| A | B | C | |
|---|---|---|---|
|
1
|
Use Case 2 CRF Question | Mapping Fidelity | RESP-NET on FHIR IG Profile Mapping |
|
2
|
A. Patient Data - THIS INFORMATION IS NOT SENT TO CDC | ||
|
3
|
Last Name | Complete | us-ph-patient.name.family |
|
4
|
First Name | Complete | us-ph-patient.name.given |
|
5
|
Middle Name | Complete | us-ph-patient.name.given |
|
6
|
Phone Number 1 | Complete | us-ph-patient.telecom |
|
7
|
Phone Number 2 | Complete | us-ph-patient.telecom |
|
8
|
Address | Complete | us-ph-patient.address.line |
|
9
|
State | Complete | us-ph-patient.address.state |
|
10
|
City | Complete | us-ph-patient.address.city |
|
11
|
Zip | Complete | us-ph-patient.address.postalCode |
|
12
|
Chart Number | Gap | |
|
13
|
Census Tract | Gap | |
|
14
|
Address Type | Gap | |
|
15
|
Name Emergency Contact 1 | Complete | us-ph-patient.contact.name WHERE relationship=Emergency Contact |
|
16
|
Emergency Contact Phone | Complete | us-ph-patient.contact.telecom WHERE relationship=Emergency Contact |
|
17
|
Name Emergency Contact 2 | Complete | us-ph-patient.contact.name WHERE relationship=Emergency Contact |
|
18
|
Emergency Contact Phone 2 | Complete | us-ph-patient.contact.telecom WHERE relationship=Emergency Contact |
|
19
|
Primary Provider Name | Complete | us-ph-patient.generalPractitioner.Practitioner.name |
|
20
|
Provider Phone Number 1 | Complete | us-ph-patient.generalPractitioner.Practitioner.telecom.value WHERE system=phone |
|
21
|
Provider Fax Number 1 | Complete | us-ph-patient.generalPractitioner.Practitioner.telecom.value WHERE system=fax |
|
22
|
Primary Provider Name 2 | Complete | us-ph-patient.generalPractitioner.Practitioner.name |
|
23
|
Provider Phone Number 2 | Complete | us-ph-patient.generalPractitioner.Practitioner.telecom.value WHERE system=phone |
|
24
|
Provider Fax Number 2 | Complete | us-ph-patient.generalPractitioner.Practitioner.telecom.value WHERE system=fax |
|
25
|
Site Use 1 | Gap | |
|
26
|
Site Use 2 | Gap | |
|
27
|
Site Use 3 | Gap | |
|
28
|
Primary Provider Clinic Name 1 | Complete | us-ph-patient.generalPractitioner.Practitioner.Organization.name |
|
29
|
Primary Provider Clinic Name 2 | Complete | us-ph-patient.generalPractitioner.Practitioner.Organization.name |
|
30
|
No PCP | Indirect | us-ph-patient.generalPractitioner(null) |
|
31
|
B. Abstractor Information - THIS INFORMATION IS NOT SENT TO CDC | ||
|
32
|
Abstractor Name | Gap | |
|
33
|
Date Reported | Gap | |
|
34
|
C. Enrollment Information | ||
|
35
|
Case ID | Gap | |
|
36
|
COVID-NET Case ID | Gap | |
|
37
|
RSV-NET Case ID | Gap | |
|
38
|
Completed by (Surveillance Officer Name) | Gap | |
|
39
|
Case Classification | Gap | |
|
40
|
State (residence of patient) | Complete | us-ph-patient.address.state |
|
41
|
County | Complete | us-ph-patient.address.district |
|
42
|
Case Type | Indirect | calculated by subtracting us-ph-patient.birthdate from us-public-health-encounter.period.start less than 18 is Pediatric, more than 18 is Adult |
|
43
|
Date of Birth | Complete | us-ph-patient.birthdate |
|
44
|
Age | Indirect | calculated by subtracting us-ph-patient.birthdate from us-public-health-encounter.period.start |
|
45
|
Age Units | Gap | |
|
46
|
Sex | Complete | us-ph-patient.extension:birthsex |
|
47
|
Race (select all that apply) | Partial | us-ph-patient.extension:race |
|
48
|
White | Complete | us-ph-patient.extension:race(White) |
|
49
|
Black or African American | Complete | us-ph-patient.extension:race(Black or African American) |
|
50
|
Asian | Complete | us-ph-patient.extension:race(Asian) |
|
51
|
Native Hawaiian or Other Pacific Islander | Complete | us-ph-patient.extension:race(Native Hawaiian or Other Pacific Islander) |
|
52
|
American Indian or Alaskan Native | Complete | us-ph-patient.extension:race(American Indian or Alaska Native) |
|
53
|
Multiracial | Gap | |
|
54
|
Not Specified | Complete | us-ph-patient.extension:race(Unknown) |
|
55
|
Ethnicity | Partial | us-ph-patient.extension:ethnicity |
|
56
|
Was patient discharged from any hospital within one week prior to the current admission date? |
Indirect/Gap
|
Calculate to see if the us-ph-encounter.period.endDate for the discharge was within one week of the us-ph-encounter.period.startDate for the current admission. |
|
57
|
Type of insurance | Indirect/Partial | |
|
58
|
Private | Indirect | |
|
59
|
Medicare | Indirect | |
|
60
|
Medicaid | Indirect | |
|
61
|
Military | Indirect | |
|
62
|
Indian Health Service | Indirect | |
|
63
|
Incarcerated | Gap | |
|
64
|
Uninsured | Gap | |
|
65
|
Unknown | Gap | |
|
66
|
Other | Gap | |
|
67
|
Other,specify | Gap | |
|
68
|
Pregnant | Complete | us-ph-pregnancy-status-observation.value |
|
69
|
Hospital ID where patient treated | Indirect | us-ph-encounter.serviceProvider.us-ph-organization.identifier |
|
70
|
Hospital ID where patient treated | Indirect | us-ph-encounter.serviceProvider.us-ph-organization.identifier |
|
71
|
Admission Date | Indirect | us-ph-encounter.period.start |
|
72
|
Discharge Date | Indirect | us-ph-encounter.period.end |
|
73
|
Was patient transferred from another hospital | Indirect | us-ph-encounter.hospitalization.admitSource= hosp-trans |
|
74
|
If yes, hospital ID | Indirect | us-ph-encounter.hospitalization.origin.us-ph-organization.identifier |
|
75
|
Transfer Admission Date | Indirect | us-ph-encounter.period WHERE eicr.encounter.reasonCode = 4563007 Hospital admission, transfer from other hospital or health care facility |
|
76
|
Transfer Date | Indirect | us-ph-encounter.period WHERE eicr.encounter.reasonCode = 4563007 Hospital admission, transfer from other hospital or health care facility |
|
77
|
Where did patient reside at the time of hospitalization? Indicate TYPE of residence. | Partial | us-ph-characteristics-of-home-environment.value |
|
79
|
If resident of a facility, indicate NAME of facility: | Indirect | us-ph-organization.name |
|
80
|
D. Influenza Testing Results | ||
|
81
|
Test 1, Test 2, Test 3, Test 4 | Indirect | us-ph-lab-result-observation.code |
|
82
|
Result 1, Result 2, Result 3, Result 4 | Indirect | us-ph-lab-result-observation.value |
|
83
|
Result - Other, specify 1, Result - Other, specify 2, Result - Other, specify 3, Result - Other, specify 4 | Indirect | us-ph-lab-result-observation.value |
|
84
|
Specimen Collection Date 1, Specimen Collection Date 2, Specimen Collection Date 3, Specimen Collection Date 4 | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
85
|
Facility ID 1, Facility ID 2, Facility ID 3, Facility ID 4 | Indirect | us-ph-lab-result-observation.performer.organization.identifier |
|
86
|
Facility ID1, Facility ID2, Facility ID3, Facility ID4 | Indirect | us-ph-lab-result-observation.performer.organization.identifier |
|
87
|
Specimen ID 1, Specimen ID 2, Specimen ID 3, Specimen ID 4 | Indirect | us-ph-lab-result-observation.specimen.accessionIdentifier |
|
88
|
E. ICU and Other Interventions | ||
|
89
|
Was patient admitted to an intensive care unit (ICU)? | Indirect | us-ph-encounter.serviceType = intensive care medicine OR pediatric intensive care medicine |
|
90
|
Date of first ICU Admission | Indirect | us-ph-encounter.period.start |
|
91
|
Unknown | Indirect | us-ph-encounter.period.start(NULL) |
|
92
|
Date of first ICU Discharge | Indirect | us-ph-encounter.period.end |
|
93
|
Unknown | Indirect | us-ph-encounter.period.end(NULL) |
|
94
|
BiPAP or CPAP use? | Indirect | us-ph-lab-result-observation.device.type |
|
95
|
High flow nasal cannula (e.g. Vapotherm) | Indirect | us-ph-lab-result-observation.device.type |
|
96
|
Invasive Mechanical Ventilation | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
97
|
Extracorporeal Membrane Oxygenation (ECMO or 'on bypass') | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
98
|
Vasopressor Use | Indirect | us-ph-medicationadministration.medication |
|
99
|
Renal Replacement Therapy (RRT) or dialysis? | Indirect | eicr-procedure.code |
|
100
|
F. Outcome | ||
|
101
|
What was the outcome of the patient? | Indirect/Gap | us-ph-patient.deceasedDateTime OR us-ph-encounter.dischargeDisposition |
|
102
|
If discharge alive, please indicate to where | Partial | us-ph-encounter.hospitalization.dischargeDisposition OR us-ph-encounter.hospitalization.discharge.location.type |
|
104
|
Notes regarding discharge diagnoses | Gap | |
|
105
|
G. Admission and Patient History | ||
|
106
|
Reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition.code OR us-ph-encounter.reasonCode |
|
107
|
Specify other reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition.code OR us-ph-encounter.reasonCode |
|
108
|
None of the below signs/symptoms | Indirect | us-ph-condition.code(null) |
|
109
|
Abdominal pain | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
110
|
Altered mental status/confusion | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
111
|
Anosmia/decreased smell | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
112
|
Chest pain | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
113
|
Conjunctivitis/pink eye | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
114
|
Diarrhea | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
115
|
Dysgeusia/decreased taste | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
116
|
Fatigue/weakness | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
117
|
Fever/chills | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
118
|
Headache | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
119
|
Myalgia/musle aches | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
120
|
Nausea/vomiting | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
121
|
Rash | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
122
|
Seizures | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
123
|
Congested/runny nose | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
124
|
Cough | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
125
|
Hemoptysis/bloody sputum | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
126
|
Shortness of breath/respiratory distress | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
127
|
Sore throat | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
128
|
URI/ILI | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
129
|
Wheezing | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
130
|
Apnea | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
131
|
Cyanosis | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
132
|
Decreased vocalization/stridor | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
133
|
Dehydration | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
134
|
Hypothermia | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
135
|
Inability to eat/poor feeding | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
136
|
Lethargy | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
137
|
Date of onset of acute respiratory symptoms | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate |
|
138
|
Unknown | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate(NULL) |
|
139
|
Not Applicable | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate(NULL) |
|
140
|
Height | Complete | us-core-body-height.value |
|
141
|
In or Cm | Complete | us-core-body-height.value.unit |
|
142
|
Height Unknown | Complete | us-core-body-height.value(NULL) |
|
143
|
Weight | Complete | us-core-body-weight.value |
|
144
|
Lbs or KG | Complete | us-core-body-weight.value.unit |
|
145
|
Weight Unknown | Complete | us-core-body-height.value(NULL) |
|
146
|
Body Mass Index | Complete | us-core-bmi.value |
|
147
|
Unknown | Complete | us-core-bmi.value(NULL) |
|
148
|
Smoker (tobacco) | Partial | us-core-smokingstatus.value |
|
149
|
Alcohol abuse | Indirect | us-ph-lab-result-observation.value |
|
150
|
Substance abuse | Indirect | us-ph-lab-result-observation.value |
|
151
|
Substance Abuse Type (current use only) | Indirect | us-ph-lab-result-observation.value |
|
152
|
Intravenous drug use (IVDU) | Indirect | us-ph-lab-result-observation.value |
|
153
|
Polysubstance abuse - not otherwise specified | Indirect | us-ph-lab-result-observation.value |
|
154
|
Opioids | Indirect | us-ph-lab-result-observation.value |
|
155
|
Cocaine | Indirect | us-ph-lab-result-observation.value |
|
156
|
Methamphetamines | Indirect | us-ph-lab-result-observation.value |
|
157
|
Marijuana | Indirect | us-ph-lab-result-observation.value |
|
158
|
Other substance abuse | Indirect | us-ph-lab-result-observation.value |
|
159
|
Substance Type, specify | Indirect | us-ph-lab-result-observation.value |
|
160
|
Substance Type unknown | Indirect | us-ph-lab-result-observation.value |
|
161
|
Code status on admission | Gap | |
|
162
|
H. Underlying Medical Conditions | ||
|
163
|
Did the patient have any of the following pre-existing conditions | Indirect | us-ph-condition.code |
|
164
|
Asthma (including reactive airway disease) | Indirect | us-ph-condition.code |
|
165
|
Chronic lung disease | Indirect | us-ph-condition.code |
|
166
|
Active tuberculosis/TB | Indirect | us-ph-condition.code |
|
167
|
Asbestosis | Indirect | us-ph-condition.code |
|
168
|
Bronchiesctasis | Indirect | us-ph-condition.code |
|
169
|
Bronchiolitis obliterans | Indirect | us-ph-condition.code |
|
170
|
Chronic bronchitis | Indirect | us-ph-condition.code |
|
171
|
Chronic respiratory failure | Indirect | us-ph-condition.code |
|
172
|
Cystic fibrosis (CF) | Indirect | us-ph-condition.code |
|
173
|
Emphysema/Chronic obstructive pulmonary disease (COPD) | Indirect | us-ph-condition.code |
|
174
|
Interstitial lung disease (ILD) | Indirect | us-ph-condition.code |
|
175
|
Oxygen (O2) dependent | Indirect | us-ph-condition.code |
|
176
|
Obstructive sleep apnea (OSA) | Indirect | us-ph-condition.code |
|
177
|
Pulmonary fibrosis | Indirect | us-ph-condition.code |
|
178
|
Restrictive lung disease | Indirect | us-ph-condition.code |
|
179
|
Sarcoidosis | Indirect | us-ph-condition.code |
|
180
|
Chronic metabolic disease (including diabetes) | Indirect | us-ph-condition.code |
|
181
|
Adrenal disorders (Addison's, Adrenal Insufficiency, Cushing syndrome, Congenital adrenal hyperplasia) | Indirect | us-ph-condition.code |
|
182
|
Diabetes mellitus (DM) | Indirect | us-ph-condition.code |
|
183
|
Glycogen or other storage diseases (see list) | Indirect | us-ph-condition.code |
|
184
|
Hyper/Hypo function of pituitary gland | Indirect | us-ph-condition.code |
|
185
|
Inborn erros of metabolism (see list) | Indirect | us-ph-condition.code |
|
186
|
Metabolic syndrome | Indirect | us-ph-condition.code |
|
187
|
Parathyroid dysfunction (Hyperparathyroidism, Hypoparathyroidism) | Indirect | us-ph-condition.code |
|
188
|
Thyroid dysfunction (Grave's disease, Hashimoto's disease, Hyperthyroidism, Hypothyroidism) | Indirect | us-ph-condition.code |
|
189
|
Blood disorders/Hemoglobinopathy | Indirect | us-ph-condition.code |
|
190
|
Alpha thalassemia | Indirect | us-ph-condition.code |
|
191
|
Aplastic anemia | Indirect | us-ph-condition.code |
|
192
|
Beta thalassemia | Indirect | us-ph-condition.code |
|
193
|
Coagulopathy (Factor V Leiden, Von Willebrand Disease (VWD), see list) | Indirect | us-ph-condition.code |
|
194
|
Hemoglobin S-beta thalassemia | Indirect | us-ph-condition.code |
|
195
|
Leukopenia | Indirect | us-ph-condition.code |
|
196
|
Myelodysplastic syndrome (MDS) | Indirect | us-ph-condition.code |
|
197
|
Neutropenia | Indirect | us-ph-condition.code |
|
198
|
Pancytopenia | Indirect | us-ph-condition.code |
|
199
|
Polycythemia vera | Indirect | us-ph-condition.code |
|
200
|
Polycythemia vera (database only) | Indirect | us-ph-condition.code |
|
201
|
Sickle cell disease | Indirect | us-ph-condition.code |
|
202
|
Splenectomy/Asplenia | Indirect | us-ph-condition.code |
|
203
|
Thrombocytopenia | Indirect | us-ph-condition.code |
|
204
|
Chronic Cardiovascular disease | Indirect | us-ph-condition.code |
|
205
|
Aortic aneurysm (AAA), history of | Indirect | us-ph-condition.code |
|
206
|
Aortic/Mitral/Tricuspid/Pulmonic valve replacement, history of | Indirect | us-ph-condition.code |
|
207
|
Aortic regurgitation (AR) | Indirect | us-ph-condition.code |
|
208
|
Aortic stenosis (AS) | Indirect | us-ph-condition.code |
|
209
|
Atherosclerotic cardiovascular disease (ASCVD) | Indirect | us-ph-condition.code |
|
210
|
Atrial fibrillation (AFib) | Indirect | us-ph-condition.code |
|
211
|
Atrioventricular (AV) blocks | Indirect | us-ph-condition.code |
|
212
|
Automated implantable devices (AID/AICD)/Pacemaker | Indirect | us-ph-condition.code |
|
213
|
Bundle branch block (BBB/RBBB/LBBB) | Indirect | us-ph-condition.code |
|
214
|
Cardiomyopathy | Indirect | us-ph-condition.code |
|
215
|
Carotid stenosis | Indirect | us-ph-condition.code |
|
216
|
Cerebral vascular accident (CVA)/Incident/Stroke, history of | Indirect | us-ph-condition.code |
|
217
|
Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
218
|
Atrial septal defect | Indirect | us-ph-condition.code |
|
219
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
220
|
Tetralogy of fallot | Indirect | us-ph-condition.code |
|
221
|
Ventricular septal defect | Indirect | us-ph-condition.code |
|
222
|
Other congenital heart disease, specify | Indirect | us-ph-condition.code |
|
223
|
Other Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
224
|
Coronary artery bypass grafting (CABG), history of | Indirect | us-ph-condition.code |
|
225
|
Coronary artery disease (CAD) | Indirect | us-ph-condition.code |
|
226
|
Deep vein thrombosis (DVT), history of | Indirect | us-ph-condition.code |
|
227
|
Heart failure/Congenital heart failure (CHF) | Indirect | us-ph-condition.code |
|
228
|
Myocardial infarction (MI), history of | Indirect | us-ph-condition.code |
|
229
|
Mitral regurgitation (MR) | Indirect | us-ph-condition.code |
|
230
|
Mitral stenosis (MS) | Indirect | us-ph-condition.code |
|
231
|
Peripheral artery disease (PAD) | Indirect | us-ph-condition.code |
|
232
|
Peripheral vascular disease (PVD) | Indirect | us-ph-condition.code |
|
233
|
Pulmonary embolism (PE), history of | Indirect | us-ph-condition.code |
|
234
|
Pulmonary hypertension (PHTN) | Indirect | us-ph-condition.code |
|
235
|
Pulmonic regurgitation | Indirect | us-ph-condition.code |
|
236
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
237
|
Transient ischemic attack (TIA), history of | Indirect | us-ph-condition.code |
|
238
|
Tricuspid regurgitation (TR) | Indirect | us-ph-condition.code |
|
239
|
Tricuspid stenosis | Indirect | us-ph-condition.code |
|
240
|
Ventricular fibrillation (VF, VFib), history of | Indirect | us-ph-condition.code |
|
241
|
Ventricular tachycardia (VT, VTach), history of | Indirect | us-ph-condition.code |
|
242
|
Neurologic disorders | Indirect | us-ph-condition.code |
|
243
|
Amyotrophic lateral sclerosis (ALS) | Indirect | us-ph-condition.code |
|
244
|
Cerebral palsy | Indirect | us-ph-condition.code |
|
245
|
Cognitive dysfunction | Indirect | us-ph-condition.code |
|
246
|
Dementia/Alzheimer's disease | Indirect | us-ph-condition.code |
|
247
|
Developmental delay | Indirect | us-ph-condition.code |
|
248
|
Down syndrome/Trisomy 21 | Indirect | us-ph-condition.code |
|
249
|
Edwards syndrome/Trisomy 18 | Indirect | us-ph-condition.code |
|
250
|
Epilepsy/Seizure/Seizure disorder | Indirect | us-ph-condition.code |
|
251
|
Mitochondiral disorder | Indirect | us-ph-condition.code |
|
252
|
Multiple sclerosis (MS) | Indirect | us-ph-condition.code |
|
253
|
Muscular dystrophy (see list) | Indirect | us-ph-condition.code |
|
254
|
Myasthenia gravis (MG) | Indirect | us-ph-condition.code |
|
255
|
Neural tube defects/Spina bifida (see list) | Indirect | us-ph-condition.code |
|
256
|
Neuropathy | Indirect | us-ph-condition.code |
|
257
|
Parkinson's disease | Indirect | us-ph-condition.code |
|
258
|
Plegias/Paralysis/Quadriplegia | Indirect | us-ph-condition.code |
|
259
|
Scoliosis/Kyphoscholiosis | Indirect | us-ph-condition.code |
|
260
|
Traumatic brain injury (TBI), history of | Indirect | us-ph-condition.code |
|
261
|
History of Guillain-Barre syndrome | Indirect | us-ph-condition.code |
|
262
|
Immunocompromised condition | Indirect | us-ph-condition.code |
|
263
|
AIDS or CD4 count < 200 | Indirect | us-ph-condition.code |
|
264
|
Complement deficiency (see list) | Indirect | us-ph-condition.code |
|
265
|
Grafts vs. Host disease (GVHD) | Indirect | us-ph-condition.code |
|
266
|
HIV infection | Indirect | us-ph-condition.code |
|
267
|
Immunoglobulin deficiency/Immunodeficiency (see list) | Indirect | us-ph-condition.code |
|
268
|
Immunosuppressive therapy (within the last 12 months of admission) (see list) | Indirect | us-ph-condition.code |
|
269
|
If yes, for what condition? | Indirect | us-ph-condition.code |
|
270
|
Leukemia* | Indirect | us-ph-condition.code |
|
271
|
Lymphoma/Hodgkins/Non-Hodgkins (NHL)* | Indirect | us-ph-condition.code |
|
272
|
Metastatic cancer* | Indirect | us-ph-condition.code |
|
273
|
Multiple myeloma* | Indirect | us-ph-condition.code |
|
274
|
Solid organ malignancy* | Indirect | us-ph-condition.code |
|
275
|
If yes, which organ? | Indirect | us-ph-condition.code |
|
276
|
Steroid therapy (within 2 weeks of admission) | Indirect | us-ph-condition.code |
|
277
|
Transplant, hematopoietic stem cell (Bone marrow transplant BMT), Peripheral stem cell transplant (PSCT), history of | Indirect | us-ph-condition.code |
|
278
|
Transplant, solid organ (SOT), history of | Indirect | us-ph-condition.code |
|
279
|
Any obesity | Indirect | us-ph-condition.code |
|
280
|
Severely/morbidly obese | Indirect | us-ph-condition.code |
|
281
|
Obesity | Indirect | us-ph-condition.code |
|
282
|
Post-partum (two weeks or less) | Indirect | us-ph-condition.code |
|
283
|
Renal disease | Indirect | us-ph-condition.code |
|
284
|
Chronic kidney disease (CKD)/Chronic renal insufficiency (CRI) | Indirect | us-ph-condition.code |
|
285
|
End-stage renal disease/Dialysis (ESRD) | Indirect | us-ph-condition.code |
|
286
|
Dialysis (HD) | Indirect | us-ph-condition.code |
|
287
|
Glomerulonephritis (GN) | Indirect | us-ph-condition.code |
|
288
|
Nephrotic syndrome | Indirect | us-ph-condition.code |
|
289
|
Polycystic kidney disease (PCKD) | Indirect | us-ph-condition.code |
|
290
|
Liver disease Gastrointestinal/Liver Disease (Do not record GERD) | Indirect | us-ph-condition.code |
|
291
|
Alcoholic hepatitis | Indirect | us-ph-condition.code |
|
292
|
Autoimmune hepatitis | Indirect | us-ph-condition.code |
|
293
|
Barrett's esophagitis | Indirect | us-ph-condition.code |
|
294
|
Chronic liver disease | Indirect | us-ph-condition.code |
|
295
|
Chronic pancreatitis | Indirect | us-ph-condition.code |
|
296
|
Cirrhosis/End stage liver disease (ESLD) | Indirect | us-ph-condition.code |
|
297
|
Crohn's disease | Indirect | us-ph-condition.code |
|
298
|
Esophageal strictures | Indirect | us-ph-condition.code |
|
299
|
Esophageal varices | Indirect | us-ph-condition.code |
|
300
|
Hepatitis B, chronic (HBV) | Indirect | us-ph-condition.code |
|
301
|
Hepatitis C, chronic (HCV) | Indirect | us-ph-condition.code |
|
302
|
Non-alcoholic fatty liver disease/NASH/NAFLD | Indirect | us-ph-condition.code |
|
303
|
Ulcerative colitis (UC) | Indirect | us-ph-condition.code |
|
304
|
Rheumatologic/Autoimmune/Inflammatory Conditions (Do not record Osteoarthritis/OA) | Indirect | us-ph-condition.code |
|
305
|
Ankylosing spondylitis | Indirect | us-ph-condition.code |
|
306
|
Dermatomyositis | Indirect | us-ph-condition.code |
|
307
|
Juvenile idiopathic arthritis | Indirect | us-ph-condition.code |
|
308
|
Kawasaki disease | Indirect | us-ph-condition.code |
|
309
|
Microscopic polyangiitis | Indirect | us-ph-condition.code |
|
310
|
Polyarteritis nodosum (PAN) | Indirect | us-ph-condition.code |
|
311
|
Polymyalgia rheumatica | Indirect | us-ph-condition.code |
|
312
|
Polymyositis | Indirect | us-ph-condition.code |
|
313
|
Psoriatic arthritis | Indirect | us-ph-condition.code |
|
314
|
Rheumatoid arthritis (RA) | Indirect | us-ph-condition.code |
|
315
|
Systemic Lupus erythematosus/SLE/Lupus | Indirect | us-ph-condition.code |
|
316
|
Systemic sclerosis | Indirect | us-ph-condition.code |
|
317
|
Takaysu arteritis | Indirect | us-ph-condition.code |
|
318
|
Temporal/Giant cell arteritis | Indirect | us-ph-condition.code |
|
319
|
Vasculitis, other (see list) | Indirect | us-ph-condition.code |
|
320
|
Hypertension | Indirect | us-ph-condition.code |
|
321
|
Mental Health Conditions | Indirect | us-ph-condition.code |
|
322
|
Bipolar | Indirect | us-ph-condition.code |
|
323
|
Depression | Indirect | us-ph-condition.code |
|
324
|
Schizophrenia spectrum disorder | Indirect | us-ph-condition.code |
|
325
|
Other | Indirect | us-ph-condition.code |
|
326
|
Feeding tube (PEG, see list) | Indirect | us-ph-condition.code |
|
327
|
Trach dependent/Vent dependent | Indirect | us-ph-condition.code |
|
328
|
Wheelchair dependent | Indirect | us-ph-condition.code |
|
329
|
Other | Indirect | us-ph-condition.code |
|
330
|
Other, specify | Indirect | us-ph-condition.code |
|
331
|
Abnormality of upper airway (see instructions) | Indirect | us-ph-condition.code |
|
332
|
Chronic lung disease of prematurity/Bronchopulmonary dysplasia (BPD) | Indirect | us-ph-condition.code |
|
333
|
History of febrile seizures | Indirect | us-ph-condition.code |
|
334
|
Long-term aspirin therapy | Indirect | us-ph-condition.code |
|
335
|
Premature (gestation age <37weeks at birth for patients <2 yrs) | Indirect | us-ph-condition.code |
|
336
|
Gestation age at birth in weeks | Gap | |
|
337
|
Unknown gestational age at birth | Gap | |
|
338
|
I. Bacterial Pathogens | ||
|
339
|
Were any culture tests performed within 3 days prior to or 3 days following admission? | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
340
|
If yes, what is the specimen source? | Indirect | us-ph-lab-result-observation.specimen.type |
|
341
|
Blood | Indirect | us-ph-lab-result-observation.specimen.type |
|
342
|
Bronchoalveolar lavage (BAL) | Indirect | us-ph-lab-result-observation.specimen.type |
|
343
|
Pleural fluid | Indirect | us-ph-lab-result-observation.specimen.type |
|
344
|
Cerebrospinal fluid (CSF) | Indirect | us-ph-lab-result-observation.specimen.type |
|
345
|
Sputum | Indirect | us-ph-lab-result-observation.specimen.type |
|
346
|
Endotracheal Aspirate | Indirect | us-ph-lab-result-observation.specimen.type |
|
347
|
Other | Indirect | us-ph-lab-result-observation.specimen.type |
|
348
|
Specify | Indirect | us-ph-lab-result-observation.specimen.type.text |
|
349
|
Date of specimen collection for culture | Indirect | us-ph-lab-result-observation.specimen.collectedDateTime |
|
350
|
If yes, was there a positive culture for a bacterial pathogen? | Indirect | us-ph-lab-result-observation.value |
|
351
|
Pathogen 1, Pathogen 2, Pathogen 3, Pathogen 4, Pathogen 5, Pathogen 6, Pathogen 7, Pathogen 8, Pathogen 9, Pathogen 10 | Indirect | us-ph-lab-result-observation.value |
|
352
|
Pathogen 1 (database only), Pathogen 2 (database only), Pathogen 3 (database only), Pathogen 4 (database only), Pathogen 5 (database only), Pathogen 6 (database only), Pathogen 7 (database only), Pathogen 8 (database only), Pathogen 9 (database only), Pathogen 10 (database only) | Indirect | us-ph-lab-result-observation.value |
|
353
|
If Staphylococcus aureus, specify | Indirect | us-ph-lab-result-observation.value |
|
354
|
J. Viral Pathogens | ||
|
355
|
Was patient tested for any of the following viral respiratory pathogens within 14 days prior to admission or ≤3 days after admission?) | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
356
|
RSV | Indirect | us-ph-lab-result-observation.value |
|
357
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
358
|
Adenovirus | Indirect | us-ph-lab-result-observation.value |
|
359
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
360
|
Parainfluenza 1, Parainfluenza 2, Parainfluenza 3, Parainfluenza 4 | Indirect | us-ph-lab-result-observation.value |
|
361
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
362
|
Human metapneumovirus | Indirect | us-ph-lab-result-observation.value |
|
363
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
364
|
Rhinovirus/Enterovirus | Indirect | us-ph-lab-result-observation.value |
|
365
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
366
|
Coronavirus (SARS-CoV-2) Result | Indirect | us-ph-lab-result-observation.value |
|
367
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
368
|
Coronavirus (type) | Indirect | us-ph-lab-result-observation.value |
|
369
|
Coronavirus | Indirect | us-ph-lab-result-observation.value |
|
370
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
371
|
K. Influenza Treatment | ||
|
372
|
Did the patient receive treatment with an antiviral medication for influenza at any time during the course of this illness? | Indirect | us-ph-medicationadministration.medication = antiviral medication for influenza |
|
373
|
Treatment 1, Treatment 2, Treatment 3, Treatment 4 | Indirect | us-ph-medicationadministration.medication.code.coding |
|
374
|
Treatment 1, specify, Treatment 2, specify, Treatment 3, specify, Treatment 4, specify | Indirect | us-ph-medicationadministration.medication.code.text |
|
375
|
Start Date | Indirect | us-ph-medicationadministration.effectiveDateTime |
|
376
|
Start Date, unknown | Indirect | us-ph-medicationadministration.effectiveDateTime |
|
377
|
Additional Treatment Comments | Indirect | us-ph-medicationadministration.note |
|
378
|
L. Chest Imaging | ||
|
379
|
Chest X-ray (within 3 days of admission) | Indirect | us-ph-lab-result-observation.code and effectiveTime |
|
380
|
Were any of these chest x-rays abnormal? | Indirect | us-ph-lab-result-observation.value |
|
381
|
Date of first abnormal chest x-ray | Indirect | us-ph-lab-result-observation.effectiveTime |
|
382
|
Report not available | Indirect | us-ph-lab-result-observation.value |
|
383
|
Air space density | Indirect | us-ph-lab-result-observation.value |
|
384
|
Air space opactiy | Indirect | us-ph-lab-result-observation.value |
|
385
|
Bronchopneumonia/Pneumonia | Indirect | us-ph-lab-result-observation.value |
|
386
|
Cannot rule out pnuemonia | Indirect | us-ph-lab-result-observation.value |
|
387
|
Consolidation | Indirect | us-ph-lab-result-observation.value |
|
388
|
Cavitation | Indirect | us-ph-lab-result-observation.value |
|
389
|
ARDS (acute respiratory distress syndrome) | Indirect | us-ph-lab-result-observation.value |
|
390
|
Pleural effusion/empyema | Indirect | us-ph-lab-result-observation.value |
|
391
|
Empyema | Indirect | us-ph-lab-result-observation.value |
|
392
|
Lung infiltrate | Indirect | us-ph-lab-result-observation.value |
|
393
|
Interstitial infiltrate | Indirect | us-ph-lab-result-observation.value |
|
394
|
Lobar (NOT interstitial) infiltrate | Indirect | us-ph-lab-result-observation.value |
|
395
|
Other | Indirect | us-ph-lab-result-observation.value |
|
396
|
M. Discharge Summary | ||
|
397
|
Did the patient have any of the following diagnoses at discharge (check all that apply) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
398
|
No discharge summary available | Gap | Gap |
|
399
|
Acute encephalopathy/Encephalitis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
400
|
Acute liver failure | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
401
|
Acute Myocardial Infarction | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
402
|
Acute myocarditis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
403
|
Acute Renal Failure/Acute Kidney Inury | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
404
|
Acute Respiratory Distress Syndrome (ARDS) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
405
|
Acute respiratory failure | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
406
|
Asthma exacerbation | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
407
|
Bacteremia | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
408
|
Bronchiolitis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
409
|
Bronchitis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
410
|
Chronic lung disease of prematuriyy/BPD | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
411
|
Congestive Heart Failure (CHF) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
412
|
COPD exacerbation | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
413
|
Deep Vein Thrombosis (DVT) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
414
|
Diabetic Ketoacidosis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
415
|
Disseminated intravascular coagulation | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
416
|
Guillain-Barre Syndrome (GBS) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
417
|
Hemophagocytic Syndrome | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
418
|
Invasive pulmonary aspergillosis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
419
|
Kawasaki disease | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
420
|
Mucormycosis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
421
|
Multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
422
|
Other thrombosis/embolism/coagulopathy | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
423
|
Pneumonia | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
424
|
Pulmonary Embolism (PE) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
425
|
Reye's Syndrome | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
426
|
Rhabdomyolysis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
427
|
Sepsis | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
428
|
Seizures | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
429
|
Stroke (CVA) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
430
|
Toxic Shock Syndrome (TSS) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
431
|
Mark "No/Unknown" for remaining discharge diagnoses? | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
432
|
N. ICD-10-CM codes Discharged Diagnoses | ||
|
433
|
From the face sheet, list ICD-9 discharge diagnoses (if available) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
434
|
Version | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
435
|
1, 2, 3, 4, 5, 6, 7, 8, 9 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
436
|
O. Pregnancy Information - To be completed for pregnant women only | ||
|
437
|
Total number of pregnancies at time of hospital admission (Gravida, G) | Indirect | us-ph-lab-result-observation.value WHERE code.text=gravida |
|
438
|
Total number of pregnancies at time of hospital admission unknown | Indirect | us-ph-lab-result-observation.value(NULL) |
|
439
|
Total number of pregnancies at time of hospital admission that resulted in a live birth | Indirect | us-ph-lab-result-observation.value WHERE code.text=parity |
|
440
|
Total number of pregnancies at time of hospital admission that resulted in a live birth Unknown | Indirect | us-ph-lab-result-observation.value(NULL) |
|
441
|
Specify total number of fetuses for current pregnancy at time of hospital admission | Indirect | us-ph-lab-result-observation.value(NULL) |
|
442
|
Specify gestational age in weeks at time of hospital admission | Gap | |
|
443
|
Gestational age in weeks at time of hospital admission unknown | Gap | |
|
444
|
Trimester of pregnancy at admission | Indirect | us-ph-lab-result-observation.value(NULL) |
|
445
|
If patient was pregnant on admission, indicate pregnancy status at discharge | Indirect | us-ph-pregnancy-status-observation.value |
|
446
|
If patient was pregnant on admission but no longer pregnant at discharge, indicate pregnancy outcome at discharge | Indirect | us-ph-pregnancy-outcome-observation.value |
|
447
|
Pre-term live birth? (<37 weeks GA) | Indirect | us-ph-pregnancy-status-observation.value |
|
448
|
Pre-term delivery, gestational age in weeks | Gap | |
|
449
|
If no longer pregnant, indicate date of delivery or end of pregnancy | Gap | |
|
450
|
If no longer pregnant, indicate date of delivery or end of pregnancy - unknown | Gap | |
|
451
|
P. Vaccination History | ||
|
452
|
Medical Chart | Gap | |
|
453
|
If yes, specify dosage date information | Gap | |
|
454
|
Date Unknown | Gap | |
|
455
|
If patient < 9 yrs, specify vaccine type: | Partial | us-core-immunization.route |
|
456
|
Vaccine Registry | Gap | |
|
457
|
If yes, specify dosage date information | Gap | |
|
458
|
Date Unknown | Gap | |
|
459
|
If patient < 9 yrs, specify vaccine type: | Partial | us-core-immunization.route |
|
460
|
Primary Care Provider/Long-Term Care Facility | Gap | |
|
461
|
If yes, specify dosage date information | Gap | |
|
462
|
Date Unknown | Gap | |
|
463
|
If patient < 9 yrs, specify vaccine type: | Partial | us-core-immunization.route |
|
464
|
Interview | Gap | |
|
465
|
Patient or Proxy | Gap | |
|
466
|
If yes, specify dosage date information | Gap | |
|
467
|
Date Unknown | Gap | |
|
468
|
If patient < 9 yrs, specify vaccine type: | Partial | us-core-immunization.route |
|
469
|
If patient < 9 years: Did patient receive any seasonal influenza vaccine in previous seasons? | Gap | |
|
470
|
If patient < 9 years: Did patient receive 2nd influenza vaccine in current season? | Gap | |
|
471
|
If yes, specify 2nd dosage date information | Gap | |
|
472
|
Date Unknown | Gap | |
|
473
|
R. Miscellaneous | ||
|
474
|
Sampled vs. non sampled case | Gap | |
|
475
|
Additional Comments | Gap | |
|
476
|
Miscellaneous (NOT ON CASE REPORT FORM) | ||
|
477
|
MMWR week | Gap | |
|
478
|
Date minimum five completed: | Gap | |
|
479
|
Case Status | Gap | |
|
480
|
CDC Track | Gap | |
|
481
|
Called PCP | Gap | |
|
482
|
Date | Gap | |
|
483
|
Note | Gap | |
|
484
|
Faxed PCP | Gap | |
|
485
|
Date | Gap | |
|
486
|
Note | Gap | |
|
487
|
Searched Vaccine Registry | Gap | |
|
488
|
Date | Gap | |
|
489
|
Note | Gap | |
|
490
|
Conducted Patient Interview | Gap | |
|
491
|
Date | Gap | |
|
492
|
Note | Gap | |
RESP-NET Disease Burden Project: Because testing for influenza and other respiratory viruses is done at the discretion of the clinician and testing practices may vary widely among facilities and over time, some people hospitalized with influenza may not be recognized and diagnosed. To better estimate the full burden of influenza, CDC collects additional information from FluSurv-NET hospitals on the proportion of patients with acute respiratory illnesses (ARI) who are tested for influenza, SARS-CoV-2, and RSV. This use case will focus on obtaining data on respiratory viral testing practices for CDC’s RESP-NET disease burden project. This project collects patient-level data on persons hospitalized with ARI (based on ICD-10 diagnosis codes) along with information about whether or not the patient was tested for influenza, SARS-CoV-2, or RSV and if so, the test result and test type used for all tests performed (patients may be tested multiple times). Additional data elements include state, age, race/ethnicity, week of admission, ICD-10 discharge diagnoses, and if possible, whether the patient had been admitted to the ICU or died during the hospital stay.
| A | B | C | |
|---|---|---|---|
|
1
|
Use Case 3 CRF Data Element | Mapping Fidelity | RESP-NET on FHIR IG Profile Mapping |
|
2
|
Case ID | Gap | |
|
3
|
Hospital ID | Indirect | us-ph-encounter.serviceProvider.us-ph-organization.identifier |
|
4
|
Zip Code | Complete | us-ph-patient.address.postalCode |
|
5
|
Admission date | Indirect | us-ph-encounter.period.start |
|
6
|
Date of Birth | Complete | us-ph-patient.birthdate |
|
7
|
Sex | Complete | us-ph-patient.extension:birthsex |
|
8
|
White Race | Complete | us-ph-patient.extension:race(White) |
|
9
|
Asian/Pacific Islander | Complete | us-ph-patient.extension:race(Asian) |
|
10
|
Black Race | Complete | us-ph-patient.extension:race(Black or African American) |
|
11
|
American Indian/Alaskan Native | Complete | us-ph-patient.extension:race(American Indian or Alaska Native) |
|
12
|
Multiracial | Gap | |
|
13
|
Other | Complete | us-ph-patient.extension:race(Unknown) |
|
14
|
Ethnicity | Complete | us-ph-patient.extension:ethnicity |
|
15
|
P and I Code 1 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use=discharge |
|
16
|
P and I Code 2 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use=discharge |
|
17
|
P and I Code 3 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use=discharge |
|
18
|
P and I Code 4 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use=discharge |
|
19
|
P and I Code 5 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use=discharge |
|
20
|
Tested for influenza | Indirect | us-ph-lab-result-observation.code |
|
21
|
Flu test result 1, Flu test result 2 | Complete | us-ph-lab-result-observation.value |
|
22
|
Flu test type 1*, Flu test type 2 | Complete | us-ph-lab-result-observation.code |
|
23
|
Tested for RSV | Indirect | us-ph-lab-result-observation.code |
|
24
|
RSV Test Result 1, RSV Test Result 2 | Complete | us-ph-lab-result-observation.value |
|
25
|
RSV Test Type 1*, RSV Test Type 2 | Complete | us-ph-lab-result-observation.code |
|
26
|
Tested for SARS- CoV-2 | Indirect | us-ph-lab-result-observation.code |
|
27
|
SARS-CoV-2 test result 1, SARS-CoV-2 test result 2 | Complete | us-ph-lab-result-observation.value |
|
28
|
SARS-CoV-2 test type 1*, SARS-CoV-2 test type 2 | Complete | us-ph-lab-result-observation.code |
|
29
|
ICU Admission | Indirect | us-ph-encounter.serviceType = intensive care medicine OR pediatric intensive care medicine |
|
30
|
Outcome | Indirect/Gap | us-ph-patient.deceasedDateTime OR us-ph-encounter.dischargeDisposition(Expired) |
Hospital-based Surveillance for SARSCoV-2: This use case focuses on collecting data similar to use case 2 but for patients who test positive for SARSCoV-2 (the virus that causes COVID-19). Public health surveillance through COVID-NET is conducted in many of the same sites as FluSurv-NET, collects many of the same data elements, with some additional data elements specific to these viral illnesses.
| A | B | C | |
|---|---|---|---|
|
1
|
Use Case 4 CRF Question | Mapping Fidelity | RESP-NET on FHIR IG Profile Mapping |
|
2
|
Header Information | ||
|
3
|
Case ID | Gap | |
|
4
|
CDC 2019-nCoV ID: | Gap | |
|
5
|
NNDSS loc. rec. ID/Case ID: | Gap | |
|
6
|
A. Patient Data - THIS INFORMATION IS NOT SENT TO CDC | ||
|
7
|
Last Name | Complete | us-ph-patient.name.family |
|
8
|
First Name | Complete | us-ph-patient.name.given |
|
9
|
Middle Name | Complete | us-ph-patient.name.given |
|
10
|
Chart Number | Gap | |
|
11
|
Address | Complete | us-ph-patient.address.line |
|
12
|
Address Type | Gap | |
|
13
|
State | Complete | us-ph-patient.address.state |
|
14
|
City | Complete | us-ph-patient.address.city |
|
15
|
Zip | Complete | us-ph-patient.address.postalCode |
|
16
|
Site Use | Gap | |
|
17
|
CDC Track | Gap | |
|
18
|
B. Abstractor Information - THIS INFORMATION IS NOT SENT TO CDC | ||
|
19
|
Abstractor Name | Gap | |
|
20
|
Date of Abstraction | Gap | |
|
21
|
C. Enrollment Information | ||
|
22
|
Admission Type | ||
|
23
|
State (residence of patient) | Complete | us-ph-patient.address.state |
|
24
|
County | Complete | us-ph-patient.address.district |
|
25
|
Case Type | Indirect | us-ph-patient.birthDate |
|
26
|
Date of Birth | Complete | us-ph-patient.birthDate |
|
27
|
Age | Indirect/Gap | |
|
28
|
Age Units | Gap | |
|
29
|
Sex | Complete | us-ph-patient.us-core-birthsex |
|
30
|
Race | Partial | us-ph-patient.us-core-race |
|
31
|
White | Indirect | us-ph-patient.us-core-race |
|
32
|
Black or African American | Indirect | us-ph-patient.us-core-race |
|
33
|
Asian | Indirect | us-ph-patient.us-core-race |
|
34
|
Native Hawaiian or Other Pacific Islander | Indirect | us-ph-patient.us-core-race |
|
35
|
American Indian or Alaskan Native | Indirect | us-ph-patient.us-core-race |
|
36
|
Multiracial | Gap | |
|
37
|
Not Specified | Indirect | us-ph-patient.us-core-race |
|
38
|
Ethnicity | Complete | us-ph-patient.us-core-ethnicity |
|
39
|
Type of insurance | Partial | us-ph-encounter.account.coverage.type |
|
40
|
Private | Partial | us-ph-encounter.account.coverage.type |
|
41
|
Medicare | Partial | us-ph-encounter.account.coverage.type |
|
42
|
Medicaid | Partial | us-ph-encounter.account.coverage.type |
|
43
|
Military | Complete | us-ph-encounter.account.coverage.type |
|
44
|
Indian Health Service | Complete | us-ph-encounter.account.coverage.type |
|
45
|
Incarcerated | Gap | |
|
46
|
Uninsured | Gap | |
|
47
|
Unknown | Gap | |
|
48
|
Other | Gap | |
|
49
|
Other,specify | Gap | |
|
50
|
Pregnant? (15-49 years of age only) | Indirect | us-ph-pregnancy-status-observation.value |
|
51
|
Hospital ID where patient treated | Indirect | us-core-organization.identifier |
|
52
|
Admission Date | Indirect | us-core-encounter.period |
|
53
|
Discharge Date | Indirect | us-core-encounter.period |
|
54
|
Was patient transferred from another hospital | Indirect | us-core-encounter.hospitalization.admitSource = hosp-trans |
|
55
|
Transfer Hospital ID | Indirect | us-core-organization.identifier |
|
56
|
Transfer Hospital Admission Date | Indirect | us-core-encounter.period |
|
57
|
Transfer Date | Indirect | us-core-encounter.period |
|
58
|
Where did patient reside at the time of hospitalization? Indicate TYPE of residence. | Gap | |
|
59
|
Other, specify | Gap | |
|
60
|
If resident of a facility, indicate NAME of facility: | Indirect | us-core-organization.name |
|
61
|
D. SARS-CoV-2 Testing Results (can add up to 10 test results in database) | ||
|
62
|
Test 1, Test 2..... | Complete | us-ph-lab-result-observation.code |
|
63
|
Specimen Collection Date 1, Specimen Collection Date 2,.... | Complete | us-ph-lab-result-observation.effectiveDateTime |
|
64
|
Specimen collection ID 1, Specimen collection ID 2,.... | Complete | us-ph-lab-result-observation.specimen.accessionIdentifier |
|
65
|
Testing Facility ID1, Testing Facility ID2, .... | Indirect | us-core-organization.identifier |
|
66
|
Test Result 1, Test Result 2, Result 3, Result 4 | Complete | us-ph-lab-result-observation.value |
|
67
|
Result - Other, specify 1, Result - Other, specify 2, Result - Other, specify 3, Result - Other, specify 4 | Complete | us-ph-lab-result-observation.value |
|
68
|
Was any sequencing completed for this patient? | Indirect | us-ph-lab-result-observation.value |
|
69
|
Sequenced Specimen Collection Date | Complete | us-ph-lab-result-observation.specimen.collection.collectedDate |
|
70
|
Sequenced Specimen Collection Date | Complete | us-ph-lab-result-observation.specimen.collection.collectedDate |
|
71
|
Sequenced Specimen Collection ID | ||
|
72
|
Sequencing Facility ID | ||
|
73
|
If yes, were any lineages identified? | Indirect | us-ph-lab-result-observation.value |
|
74
|
GENBANK ID | Indirect | specimen.accessionIdentifier |
|
75
|
GENBANK ID Unknown | Indirect | specimen.accessionIdentifier |
|
76
|
GISAID ID | Indirect | specimen.accessionIdentifier |
|
77
|
GISAID ID Unknown | Indirect | specimen.accessionIdentifier |
|
78
|
SRA ID | Indirect | specimen.accessionIdentifier |
|
79
|
SRA ID Unknown | Indirect | specimen.accessionIdentifier |
|
80
|
Did the patient have any positive SARS-CoV-2 tests >14 days prior to the current admission? | Indirect | |
|
81
|
Was patient a prior COVID-NET case? (optional) | Gap | |
|
82
|
If yes, what was the COVID-NET case ID? | Gap | |
|
83
|
E. ICU and Other Interventions | ||
|
84
|
Was patient admitted to an intensive care unit (ICU)? | Indirect | us-ph-encounter.serviceType = intensive care medicine OR pediatric intensive care medicine |
|
85
|
Date of first ICU Admission | Indirect | us-ph-encounter.period.start |
|
86
|
Unknown | Indirect | us-ph-encounter.period.start(null) |
|
87
|
Date of first ICU Discharge | Indirect | us-ph-encounter.period.end |
|
88
|
Unknown | Indirect | us-ph-encounter.period.end(null) |
|
89
|
BiPAP or CPAP use? | Indirect | us-ph-lab-result-observation.device.type |
|
90
|
High flow nasal cannula (e.g. Vapotherm) | Indirect | us-ph-lab-result-observation.device.type |
|
91
|
Invasive Mechanical Ventilation | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
92
|
Extracorporeal Membrane Oxygenation (ECMO or 'on bypass') | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
93
|
Renal Replacement Therapy (RRT) or dialysis? | Indirect | eicr-procedure.code |
|
94
|
F. Outcome | ||
|
95
|
What was the outcome of the patient upon discharge? | Indirect/Gap | us-ph-patient.deceasedDateTime OR us-ph-encounter.hospitalization.dischargeDisposition (expired) |
|
96
|
Date of death | ||
|
97
|
Date of death | ||
|
98
|
If discharge alive, please indicate to where | Partial | us-ph-encounter.hospitalization.dischargeDisposition OR us-ph-encounter.hospitalization.discharge.location.type |
|
99
|
Other, specify | Partial | us-ph-encounter.hospitalization.dischargeDisposition OR us-ph-encounter.hospitalization.discharge.location.type |
|
100
|
G. Admission and Patient History | ||
|
101
|
Reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition-problems-health-concerns.code OR us-ph-encounter.reasonReference.us-core-condition-encounter-diagnosis.code |
|
102
|
Specify other reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition-problems-health-concerns.code.text OR us-ph-encounter.reasonReference.us-core-condition-encounter-diagnosis.code.text |
|
103
|
Acute signs/symptoms present at admission (began or worsened within 2 weeks prior to admission) (Select all that apply): | ||
|
104
|
None of the below signs/symptoms | Indirect | us-ph-condition.code (null) |
|
105
|
Abdominal pain | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
106
|
Altered mental status/confusion | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
107
|
Anosmia/decreased smell | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
108
|
Chest pain | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
109
|
Conjunctivitis/pink eye | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
110
|
Diarrhea | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
111
|
Dysgeusia/decreased taste | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
112
|
Fatigue/weakness | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
113
|
Fever/chills | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
114
|
Headache | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
115
|
Myalgia/musle aches | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
116
|
Nausea/vomiting | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
117
|
Rash | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
118
|
Seizures | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
119
|
Congested/runny nose | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
120
|
Cough | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
121
|
Hemoptysis/bloody sputum | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
122
|
Shortness of breath/respiratory distress | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
123
|
Sore throat | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
124
|
URI/ILI | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
125
|
Wheezing | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
126
|
Apnea | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
127
|
Cyanosis | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
128
|
Decreased vocalization/stridor | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
129
|
Dehydration | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
130
|
Hypothermia | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
131
|
Inability to eat/poor feeding | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
132
|
Lethargy | Indirect | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.code |
|
133
|
Date of onset of acute respiratory symptoms | Complete | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.onsetDate |
|
134
|
Date of onset of acute respiratory symptoms Unknown | Complete | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.onsetDate(Null) |
|
135
|
Date of onset of acute respiratory symptoms Not Applicable | Complete | us-ph-encounter.reasonReference.us-ph-condition-problems-health-concerns.onsetDate(Null) |
|
136
|
Height | Complete | us-core-body-height.value |
|
137
|
In or Cm | Complete | us-core-body-height.value.unit |
|
138
|
Height Unknown | Complete | us-core-body-height.value (Null) |
|
139
|
Weight | Complete | us-core-body-weight.value |
|
140
|
Lbs or KG | Complete | us-core-body-weight.value.unit |
|
141
|
Weight Unknown | Complete | us-core-body-weight.value (NULL) |
|
142
|
Body Mass Index | Complete | us-core-bmi.value |
|
143
|
Body Mass Index Unknown | Complete | us-core-bmi.value (NULL) |
|
144
|
Smoker (tobacco) | Partial | us-core-smokingstatus.value |
|
145
|
Alcohol abuse | Indirect | us-ph-lab-result-observation.value |
|
146
|
Substance abuse | Indirect | us-ph-lab-result-observation.value |
|
147
|
Substance Abuse Type (current use only) | Indirect | us-ph-lab-result-observation.value |
|
148
|
Intravenous drug use (IVDU) | Indirect | us-ph-lab-result-observation.value |
|
149
|
Polysubstance abuse - not otherwise specified | Indirect | us-ph-lab-result-observation.value |
|
150
|
Opioids | Indirect | us-ph-lab-result-observation.value |
|
151
|
Cocaine | Indirect | us-ph-lab-result-observation.value |
|
152
|
Methamphetamines | Indirect | us-ph-lab-result-observation.value |
|
153
|
Marijuana | Indirect | us-ph-lab-result-observation.value |
|
154
|
Other substance abuse | Indirect | us-ph-lab-result-observation.value |
|
155
|
Substance Type, specify | Indirect | us-ph-lab-result-observation.value |
|
156
|
Substance Type unknown | Indirect | us-ph-lab-result-observation.value |
|
157
|
Code status on admission | Gap | |
|
158
|
H. First Vital Signs and First Lab Values– Questions 1 - 7 should be collected for all cases | ||
|
159
|
Heart Rate (beats/min) | Complete | us-core-heart-rate.valueQuantity |
|
160
|
Heart Rate unknown | ||
|
161
|
Respiratory Rate (breaths/min) | Complete | us-core-respiratory-rate.valueQuantity |
|
162
|
Respiratory Rate unknown | ||
|
163
|
Systolic Blood Pressure (mmHg) | Complete | us-core-blood-pressure.component:systolic.valueQuantity |
|
164
|
Systolic Blood Pressure unknown | ||
|
165
|
Diastolic Blood Pressure (mmHg) | Complete | us-core-blood-pressure.component:diastolic.valueQuantity |
|
166
|
Diastolic Blood Pressure unknown | ||
|
167
|
Temperature | Complete | us-core-body-temperature.valueQuantity |
|
168
|
Temperature unknown | ||
|
169
|
O2 saturation | ||
|
170
|
O2 saturation unknown | ||
|
171
|
Type of support required when O2 saturation was measured | ||
|
172
|
Type of support required when O2 saturation was measured - Other, specify | ||
|
173
|
Fraction of Inspired Oxygen/Flow | Indirect | us-ph-lab-result-observation.value |
|
174
|
Glasgow Coma Scale (GCS) (1-15) | Indirect | us-ph-lab-result-observation.value |
|
175
|
Glasgow Coma Scale unknown | ||
|
176
|
First labs should be collected on all pediatric cases | ||
|
177
|
White blood cell (WBC) count | Indirect | us-ph-lab-result-observation.value |
|
178
|
9. Lymphocyte count | Indirect | us-ph-lab-result-observation.value |
|
179
|
Hematocrit (HCT) | Indirect | us-ph-lab-result-observation.value |
|
180
|
Platelets (Plt) | Indirect | us-ph-lab-result-observation.value |
|
181
|
Sodium (Na) | Indirect | us-ph-lab-result-observation.value |
|
182
|
Blood Urea Nitrogen (BUN) | Indirect | us-ph-lab-result-observation.value |
|
183
|
Creatinine (Cr) | Indirect | us-ph-lab-result-observation.value |
|
184
|
Glucose | Indirect | us-ph-lab-result-observation.value |
|
185
|
Aspartate transaminase (AST) | Indirect | us-ph-lab-result-observation.value |
|
186
|
Alanine aminotransferase (ALT) | Indirect | us-ph-lab-result-observation.value |
|
187
|
C-reactive protein (CRP) | Indirect | us-ph-lab-result-observation.value |
|
188
|
Erythrocyte sedimentation rate | Indirect | us-ph-lab-result-observation.value |
|
189
|
D-dimer DDU | Indirect | us-ph-lab-result-observation.value |
|
190
|
D-dimer FEU | Indirect | us-ph-lab-result-observation.value |
|
191
|
D-dimer Type not specified | Indirect | us-ph-lab-result-observation.value |
|
192
|
Troponin T | Indirect | us-ph-lab-result-observation.value |
|
193
|
Troponin I | Indirect | us-ph-lab-result-observation.value |
|
194
|
Troponin Type not specified | Indirect | us-ph-lab-result-observation.value |
|
195
|
Procalcitonin | Indirect | us-ph-lab-result-observation.value |
|
196
|
B-type natriuretic peptide | Indirect | us-ph-lab-result-observation.value |
|
197
|
N-terminal (NT)-pro hormone BNP | Indirect | us-ph-lab-result-observation.value |
|
198
|
BNP Type not specified | Indirect | us-ph-lab-result-observation.value |
|
199
|
Arterial pH | Indirect | us-ph-lab-result-observation.value |
|
200
|
PaO2 | Indirect | us-ph-lab-result-observation.value |
|
201
|
Direct Bilirubin | Indirect | us-ph-lab-result-observation.value |
|
202
|
Ferritin | Indirect | us-ph-lab-result-observation.value |
|
203
|
IL-6 | Indirect | us-ph-lab-result-observation.value |
|
204
|
I. Underlying Medical Conditions | ||
|
205
|
Did the patient have any of the following pre-existing conditions | Indirect | us-ph-condition.code |
|
206
|
Chronic lung disease | Indirect | us-ph-condition.code |
|
207
|
Active tuberculosis/TB | Indirect | us-ph-condition.code |
|
208
|
Asbestosis | Indirect | us-ph-condition.code |
|
209
|
Asthma/Reactive airway disease | Indirect | us-ph-condition.code |
|
210
|
Bronchiesctasis | Indirect | us-ph-condition.code |
|
211
|
Bronchiolitis obliterans | Indirect | us-ph-condition.code |
|
212
|
Chronic bronchitis | Indirect | us-ph-condition.code |
|
213
|
Chronic respiratory failure | Indirect | us-ph-condition.code |
|
214
|
Cystic fibrosis (CF) | Indirect | us-ph-condition.code |
|
215
|
Emphysema/Chronic obstructive pulmonary disease (COPD) | Indirect | us-ph-condition.code |
|
216
|
Interstitial lung disease (ILD) | Indirect | us-ph-condition.code |
|
217
|
Oxygen (O2) dependent | Indirect | us-ph-condition.code |
|
218
|
Obstructive sleep apnea (OSA) | Indirect | us-ph-condition.code |
|
219
|
Pulmonary fibrosis | Indirect | us-ph-condition.code |
|
220
|
Restrictive lung disease | Indirect | us-ph-condition.code |
|
221
|
Sarcoidosis | Indirect | us-ph-condition.code |
|
222
|
Chronic metabolic disease (including diabetes) | Indirect | us-ph-condition.code |
|
223
|
Adrenal disorders (Addison's, Adrenal Insufficiency, Cushing syndrome, Congenital adrenal hyperplasia) | Indirect | us-ph-condition.code |
|
224
|
Diabetes mellitus (DM) | Indirect | us-ph-condition.code |
|
225
|
Glycogen or other storage diseases (see list) | Indirect | us-ph-condition.code |
|
226
|
Hyper/Hypo function of pituitary gland | Indirect | us-ph-condition.code |
|
227
|
Inborn erros of metabolism (see list) | Indirect | us-ph-condition.code |
|
228
|
Metabolic syndrome | Indirect | us-ph-condition.code |
|
229
|
Parathyroid dysfunction (Hyperparathyroidism, Hypoparathyroidism) | Indirect | us-ph-condition.code |
|
230
|
Thyroid dysfunction (Grave's disease, Hashimoto's disease, Hyperthyroidism, Hypothyroidism) | Indirect | us-ph-condition.code |
|
231
|
Blood disorders/Hemoglobinopathy | Indirect | us-ph-condition.code |
|
232
|
Alpha thalassemia | Indirect | us-ph-condition.code |
|
233
|
Aplastic anemia | Indirect | us-ph-condition.code |
|
234
|
Beta thalassemia | Indirect | us-ph-condition.code |
|
235
|
Coagulopathy (Factor V Leiden, Von Willebrand Disease (VWD), see list) | Indirect | us-ph-condition.code |
|
236
|
Hemoglobin S-beta thalassemia | Indirect | us-ph-condition.code |
|
237
|
Leukopenia | Indirect | us-ph-condition.code |
|
238
|
Myelodysplastic syndrome (MDS) | Indirect | us-ph-condition.code |
|
239
|
Neutropenia | Indirect | us-ph-condition.code |
|
240
|
Pancytopenia | Indirect | us-ph-condition.code |
|
241
|
Polycythemia vera | Indirect | us-ph-condition.code |
|
242
|
Polycythemia vera (database only) | Indirect | us-ph-condition.code |
|
243
|
Sickle cell disease | Indirect | us-ph-condition.code |
|
244
|
Splenectomy/Asplenia | Indirect | us-ph-condition.code |
|
245
|
Thrombocytopenia | Indirect | us-ph-condition.code |
|
246
|
Chronic Cardiovascular disease | Indirect | us-ph-condition.code |
|
247
|
Aortic aneurysm (AAA), history of | Indirect | us-ph-condition.code |
|
248
|
Aortic/Mitral/Tricuspid/Pulmonic valve replacement, history of | Indirect | us-ph-condition.code |
|
249
|
Aortic regurgitation (AR) | Indirect | us-ph-condition.code |
|
250
|
Aortic stenosis (AS) | Indirect | us-ph-condition.code |
|
251
|
Atherosclerotic cardiovascular disease (ASCVD) | Indirect | us-ph-condition.code |
|
252
|
Atrial fibrillation (AFib) | Indirect | us-ph-condition.code |
|
253
|
Atrioventricular (AV) blocks | Indirect | us-ph-condition.code |
|
254
|
Automated implantable devices (AID/AICD)/Pacemaker | Indirect | us-ph-condition.code |
|
255
|
Bundle branch block (BBB/RBBB/LBBB) | Indirect | us-ph-condition.code |
|
256
|
Cardiomyopathy | Indirect | us-ph-condition.code |
|
257
|
Carotid stenosis | Indirect | us-ph-condition.code |
|
258
|
Cerebral vascular accident (CVA)/Incident/Stroke, history of | Indirect | us-ph-condition.code |
|
259
|
Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
260
|
Atrial septal defect | Indirect | us-ph-condition.code |
|
261
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
262
|
Tetralogy of fallot | Indirect | us-ph-condition.code |
|
263
|
Ventricular septal defect | Indirect | us-ph-condition.code |
|
264
|
Other congenital heart disease, specify | Indirect | us-ph-condition.code |
|
265
|
Other Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
266
|
Coronary artery bypass grafting (CABG), history of | Indirect | us-ph-condition.code |
|
267
|
Coronary artery disease (CAD) | Indirect | us-ph-condition.code |
|
268
|
Deep vein thrombosis (DVT), history of | Indirect | us-ph-condition.code |
|
269
|
Heart failure/Congenital heart failure (CHF) | Indirect | us-ph-condition.code |
|
270
|
Myocardial infarction (MI), history of | Indirect | us-ph-condition.code |
|
271
|
Mitral regurgitation (MR) | Indirect | us-ph-condition.code |
|
272
|
Mitral stenosis (MS) | Indirect | us-ph-condition.code |
|
273
|
Peripheral artery disease (PAD) | Indirect | us-ph-condition.code |
|
274
|
Peripheral vascular disease (PVD) | Indirect | us-ph-condition.code |
|
275
|
Pulmonary embolism (PE), history of | Indirect | us-ph-condition.code |
|
276
|
Pulmonary hypertension (PHTN) | Indirect | us-ph-condition.code |
|
277
|
Pulmonic regurgitation | Indirect | us-ph-condition.code |
|
278
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
279
|
Transient ischemic attack (TIA), history of | Indirect | us-ph-condition.code |
|
280
|
Tricuspid regurgitation (TR) | Indirect | us-ph-condition.code |
|
281
|
Tricuspid stenosis | Indirect | us-ph-condition.code |
|
282
|
Ventricular fibrillation (VF, VFib), history of | Indirect | us-ph-condition.code |
|
283
|
Ventricular tachycardia (VT, VTach), history of | Indirect | us-ph-condition.code |
|
284
|
Valvular disorder not otherwise specified: | Indirect | us-ph-condition.code |
|
285
|
Neurologic disorders | Indirect | us-ph-condition.code |
|
286
|
Amyotrophic lateral sclerosis (ALS) | Indirect | us-ph-condition.code |
|
287
|
Cerebral palsy | Indirect | us-ph-condition.code |
|
288
|
Cognitive dysfunction | Indirect | us-ph-condition.code |
|
289
|
Dementia/Alzheimer's disease | Indirect | us-ph-condition.code |
|
290
|
Developmental delay | Indirect | us-ph-condition.code |
|
291
|
Down syndrome/Trisomy 21 | Indirect | us-ph-condition.code |
|
292
|
Edwards syndrome/Trisomy 18 | Indirect | us-ph-condition.code |
|
293
|
Epilepsy/Seizure/Seizure disorder | Indirect | us-ph-condition.code |
|
294
|
Mitochondiral disorder | Indirect | us-ph-condition.code |
|
295
|
Multiple sclerosis (MS) | Indirect | us-ph-condition.code |
|
296
|
Muscular dystrophy (see list) | Indirect | us-ph-condition.code |
|
297
|
Myasthenia gravis (MG) | Indirect | us-ph-condition.code |
|
298
|
Neural tube defects/Spina bifida (see list) | Indirect | us-ph-condition.code |
|
299
|
Neuropathy | Indirect | us-ph-condition.code |
|
300
|
Parkinson's disease | Indirect | us-ph-condition.code |
|
301
|
Plegias/Paralysis/Quadriplegia | Indirect | us-ph-condition.code |
|
302
|
Scoliosis/Kyphoscholiosis | Indirect | us-ph-condition.code |
|
303
|
Traumatic brain injury (TBI), history of | Indirect | us-ph-condition.code |
|
304
|
History of Guillain-Barre syndrome | Indirect | us-ph-condition.code |
|
305
|
Immunocompromised condition | Indirect | us-ph-condition.code |
|
306
|
AIDS or CD4 count < 200 | Indirect | us-ph-condition.code |
|
307
|
Complement deficiency (see list) | Indirect | us-ph-condition.code |
|
308
|
Grafts vs. Host disease (GVHD) | Indirect | us-ph-condition.code |
|
309
|
HIV infection | Indirect | us-ph-condition.code |
|
310
|
Immunoglobulin deficiency/Immunodeficiency (see list) | Indirect | us-ph-condition.code |
|
311
|
Immunosuppressive therapy (within the last 12 months of admission) (see list) | Indirect | us-ph-condition.code |
|
312
|
If yes, for what condition? | Indirect | us-ph-condition.code |
|
313
|
Leukemia* | Indirect | us-ph-condition.code |
|
314
|
Lymphoma/Hodgkins/Non-Hodgkins (NHL)* | Indirect | us-ph-condition.code |
|
315
|
Metastatic cancer* | Indirect | us-ph-condition.code |
|
316
|
Multiple myeloma* | Indirect | us-ph-condition.code |
|
317
|
Solid organ malignancy* | Indirect | us-ph-condition.code |
|
318
|
If yes, which organ? | Indirect | us-ph-condition.code |
|
319
|
Steroid therapy (within 2 weeks of admission) | Indirect | us-ph-condition.code |
|
320
|
Transplant, hematopoietic stem cell (Bone marrow transplant BMT), Peripheral stem cell transplant (PSCT), history of | Indirect | us-ph-condition.code |
|
321
|
Transplant, solid organ (SOT), history of | Indirect | us-ph-condition.code |
|
322
|
Any obesity | Indirect | us-ph-condition.code |
|
323
|
Severely/morbidly obese | Indirect | us-ph-condition.code |
|
324
|
Obese | Indirect | us-ph-condition.code |
|
325
|
Post-partum (two weeks or less) | Indirect | us-ph-condition.code |
|
326
|
Renal disease | Indirect | us-ph-condition.code |
|
327
|
Chronic kidney disease (CKD)/Chronic renal insufficiency (CRI) | Indirect | us-ph-condition.code |
|
328
|
End-stage renal disease/Dialysis (ESRD) | Indirect | us-ph-condition.code |
|
329
|
Dialysis (HD) | Indirect | us-ph-condition.code |
|
330
|
Glomerulonephritis (GN) | Indirect | us-ph-condition.code |
|
331
|
Nephrotic syndrome | Indirect | us-ph-condition.code |
|
332
|
Polycystic kidney disease (PCKD) | Indirect | us-ph-condition.code |
|
333
|
Gastrointestinal/Liver Disease (Do not record GERD) | Indirect | us-ph-condition.code |
|
334
|
Alcoholic hepatitis | Indirect | us-ph-condition.code |
|
335
|
Autoimmune hepatitis | Indirect | us-ph-condition.code |
|
336
|
Barrett's esophagitis | Indirect | us-ph-condition.code |
|
337
|
Chronic liver disease | Indirect | us-ph-condition.code |
|
338
|
Chronic pancreatitis | Indirect | us-ph-condition.code |
|
339
|
Cirrhosis/End stage liver disease (ESLD) | Indirect | us-ph-condition.code |
|
340
|
Crohn's disease | Indirect | us-ph-condition.code |
|
341
|
Esophageal strictures | Indirect | us-ph-condition.code |
|
342
|
Esophageal varices | Indirect | us-ph-condition.code |
|
343
|
Hepatitis B, chronic (HBV) | Indirect | us-ph-condition.code |
|
344
|
Hepatitis C, chronic (HCV) | Indirect | us-ph-condition.code |
|
345
|
Non-alcoholic fatty liver disease/NASH/NAFLD | Indirect | us-ph-condition.code |
|
346
|
Ulcerative colitis (UC) | Indirect | us-ph-condition.code |
|
347
|
Rheumatologic/Autoimmune/Inflammatory Conditions (Do not record Osteoarthritis/OA) | Indirect | us-ph-condition.code |
|
348
|
Ankylosing spondylitis | Indirect | us-ph-condition.code |
|
349
|
Dermatomyositis | Indirect | us-ph-condition.code |
|
350
|
Juvenile idiopathic arthritis | Indirect | us-ph-condition.code |
|
351
|
Kawasaki disease | Indirect | us-ph-condition.code |
|
352
|
Microscopic polyangiitis | Indirect | us-ph-condition.code |
|
353
|
Polyarteritis nodosum (PAN) | Indirect | us-ph-condition.code |
|
354
|
Polymyalgia rheumatica | Indirect | us-ph-condition.code |
|
355
|
Polymyositis | Indirect | us-ph-condition.code |
|
356
|
Psoriatic arthritis | Indirect | us-ph-condition.code |
|
357
|
Rheumatoid arthritis (RA) | Indirect | us-ph-condition.code |
|
358
|
Systemic Lupus erythematosus/SLE/Lupus | Indirect | us-ph-condition.code |
|
359
|
Systemic sclerosis | Indirect | us-ph-condition.code |
|
360
|
Takaysu arteritis | Indirect | us-ph-condition.code |
|
361
|
Temporal/Giant cell arteritis | Indirect | us-ph-condition.code |
|
362
|
Vasculitis, other (see list) | Indirect | us-ph-condition.code |
|
363
|
Other | Indirect | us-ph-condition.code |
|
364
|
Feeding tube (PEG, see list) | Indirect | us-ph-condition.code |
|
365
|
Trach dependent/Vent dependent | Indirect | us-ph-condition.code |
|
366
|
Wheelchair dependent | Indirect | us-ph-condition.code |
|
367
|
Other | Indirect | us-ph-condition.code |
|
368
|
Other, specify | Indirect | us-ph-condition.code |
|
369
|
Abnormality of upper airway (see instructions) | Indirect | us-ph-condition.code |
|
370
|
Chronic lung disease of prematurity/Bronchopulmonary dysplasia (BPD) | Indirect | us-ph-condition.code |
|
371
|
History of febrile seizures | Indirect | us-ph-condition.code |
|
372
|
Long-term aspirin therapy | Indirect | us-ph-condition.code |
|
373
|
Premature (gestation age <37weeks at birth for patients <2 yrs) | Indirect | us-ph-condition.code |
|
374
|
Gestation age at birth in weeks | Gap | |
|
375
|
Unknown gestational age at birth | Indirect | us-ph-condition.code |
|
376
|
J. Bacterial Pathogens | ||
|
377
|
Were any culture tests performed within 7 days of admission? | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
378
|
If yes, specify Pathogen 1: | Complete | us-ph-lab-result-observation.value |
|
379
|
If yes, specify Pathogen 1: Other | ||
|
380
|
Date of culture | Complete | Specimen.collectedDateTime |
|
381
|
Site where pathogen identified: | ||
|
382
|
Site where pathogen identified: Other, specify | ||
|
383
|
If Staphylococcus aureus, specify | ||
|
384
|
If yes, specify Pathogen 2: | ||
|
385
|
Date of culture: | ||
|
386
|
Site where pathogen identified: | ||
|
387
|
Site where pathogen identified: Other, specify | ||
|
388
|
If Staphylococcus aureus, specify | ||
|
389
|
K. Viral Pathogens | ||
|
390
|
Was patient tested for any of the following viral respiratory pathogens within 14 days prior to admission or ≤3 days after admission?) | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
391
|
RSV | Indirect | us-ph-lab-result-observation.value |
|
392
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
393
|
Flu A | Indirect | us-ph-lab-result-observation.value |
|
394
|
Flu A Type | Indirect | us-ph-lab-result-observation.value |
|
395
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
396
|
Flu B | Indirect | us-ph-lab-result-observation.value |
|
397
|
Flu B Type | Indirect | us-ph-lab-result-observation.value |
|
398
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
399
|
Flu (no subype specified) | Indirect | us-ph-lab-result-observation.value |
|
400
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
401
|
Adenovirus | Indirect | us-ph-lab-result-observation.value |
|
402
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
403
|
Parainfluenza 1, Parainfluenza 2, Parainfluenza 3, Parainfluenza 4 | Indirect | us-ph-lab-result-observation.value |
|
404
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
405
|
Human metapneumovirus | Indirect | us-ph-lab-result-observation.value |
|
406
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
407
|
Rhinovirus/Enterovirus | Indirect | us-ph-lab-result-observation.value |
|
408
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
409
|
Coronavirus 229E | Indirect | us-ph-lab-result-observation.value |
|
410
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
411
|
Coronavirus HKU1 | Indirect | us-ph-lab-result-observation.value |
|
412
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
413
|
Coronavirus NL63 | Indirect | us-ph-lab-result-observation.value |
|
414
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
415
|
Coronavirus OC43 | Indirect | us-ph-lab-result-observation.value |
|
416
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
417
|
Coronavirus (no subtype specified) | Indirect | us-ph-lab-result-observation.value |
|
418
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
419
|
K. Influenza Treatment | ||
|
420
|
Did the patient receive treatment for COVID-19 illness? | Indirect | us-ph-medicationadministration.medication = antiviral medication for influenza |
|
421
|
Azithromycin | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
422
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
423
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
424
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
425
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
426
|
Baricitinib (Olumiant) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
427
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
428
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
429
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
430
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
431
|
Bamlanivimab | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
432
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
433
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
434
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
435
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
436
|
Casirivimab/Imdevimab (REGN-COV2) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
437
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
438
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
439
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
440
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
441
|
Convalescent plasma | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
442
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
443
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
444
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
445
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
446
|
Hydroxychloroquine (Plaquenil) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
447
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
448
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
449
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
450
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
451
|
IVIG | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
452
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
453
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
454
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
455
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
456
|
Remdesivir (Veklury) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
457
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
458
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
459
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
460
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
461
|
Sarilumab (Kevzara) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
462
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
463
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
464
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
465
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
466
|
Tocilizumab (Actemra) | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
467
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
468
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
469
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
470
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
471
|
Unknown | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
472
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
473
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
474
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
475
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
476
|
Vitamin C/Ascorbic acid | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
477
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
478
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
479
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
480
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
481
|
Zinc | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
482
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
483
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
484
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
485
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
486
|
Study drug 1, specify: | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
487
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
488
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
489
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
490
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
491
|
Study drug 2, specify: | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
492
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
493
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
494
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
495
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
496
|
Study drug 3, specify: | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
497
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
498
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
499
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
500
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
501
|
Other, specify: | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
502
|
Start Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
503
|
Start Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
504
|
End Date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
505
|
End Date, unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
506
|
Systemic Steroids? | Indirect | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
507
|
Cortisone acetate | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
508
|
Dexamethansone | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
509
|
Hydrocortisone | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
510
|
Methylprednisolone | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
511
|
Prednisolone | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
512
|
Prednisone | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
513
|
Unknown | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
514
|
Systemic Steroids? Yes Other, specify | Complete | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
515
|
Systemic steroid start date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
516
|
Systemic steroid start date unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
517
|
Systemic steroid end date | Complete | us-ph-medicationadministration.effectiveDateTime |
|
518
|
Systemic steroid end date unknown | Complete | us-ph-medicationadministration.effectiveDateTime |
|
519
|
Vasopressor use? | Indirect | us-ph-medicationadministration.medicationReference:us-core-medication.code |
|
520
|
M. Chest Imaging | ||
|
521
|
Was a chest x-ray taken during hospitalization? | Indirect | us-ph-lab-result-observation.code |
|
522
|
Were any of these chest x-rays abnormal? | Indirect | us-ph-lab-result-observation.value |
|
523
|
Date of first abnormal chest x-ray | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
524
|
If yes, please check all that apply: | ||
|
525
|
Report not available | Indirect | us-ph-lab-result-observation.value |
|
526
|
Air space density | Indirect | us-ph-lab-result-observation.value |
|
527
|
Air space opactiy | Indirect | us-ph-lab-result-observation.value |
|
528
|
Bronchopneumonia/Pneumonia | Indirect | us-ph-lab-result-observation.value |
|
529
|
Cannot rule out pnuemonia | Indirect | us-ph-lab-result-observation.value |
|
530
|
Consolidation | Indirect | us-ph-lab-result-observation.value |
|
531
|
Cavitation | Indirect | us-ph-lab-result-observation.value |
|
532
|
ARDS (acute respiratory distress syndrome) | Indirect | us-ph-lab-result-observation.value |
|
533
|
Pleural effusion/empyema | Indirect | us-ph-lab-result-observation.value |
|
534
|
Empyema | Indirect | us-ph-lab-result-observation.value |
|
535
|
Lung infiltrate | Indirect | us-ph-lab-result-observation.value |
|
536
|
Interstitial infiltrate | Indirect | us-ph-lab-result-observation.value |
|
537
|
Lobar (NOT interstitial) infiltrate | Indirect | us-ph-lab-result-observation.value |
|
538
|
Other | Indirect | us-ph-lab-result-observation.value |
|
539
|
Was a chest CT/MRI taken during hospitalization? | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
540
|
Were any of these chest CT/MRIs abnormal? | Indirect | us-ph-lab-result-observation.value |
|
541
|
Date of first abnormal chest CT/MRI: | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
542
|
For first abnormal chest CT/MRI, please check all that apply: | ||
|
543
|
Report not available | Indirect | us-ph-lab-result-observation.value |
|
544
|
Air space density | Indirect | us-ph-lab-result-observation.value |
|
545
|
Air space opacity/opacification | Indirect | us-ph-lab-result-observation.value |
|
546
|
Bronchopneumonia/Pneumonia | Indirect | us-ph-lab-result-observation.value |
|
547
|
Consolidation | Indirect | us-ph-lab-result-observation.value |
|
548
|
ARDS (acute respiratory distress syndrome) | Indirect | us-ph-lab-result-observation.value |
|
549
|
Lung infiltrate | Indirect | us-ph-lab-result-observation.value |
|
550
|
Interstitial infiltrate | Indirect | us-ph-lab-result-observation.value |
|
551
|
Lobar infiltrate | Indirect | us-ph-lab-result-observation.value |
|
552
|
Pleural effusion | Indirect | us-ph-lab-result-observation.value |
|
553
|
Empyema | Indirect | us-ph-lab-result-observation.value |
|
554
|
Pneumothorax | Indirect | us-ph-lab-result-observation.value |
|
555
|
Pneumomediastinum | Indirect | us-ph-lab-result-observation.value |
|
556
|
Widened mediastinum | Indirect | us-ph-lab-result-observation.value |
|
557
|
Enlarged epiglottis | Indirect | us-ph-lab-result-observation.value |
|
558
|
Tracheal narrowing | Indirect | us-ph-lab-result-observation.value |
|
559
|
Ground glass opacities | Indirect | us-ph-lab-result-observation.value |
|
560
|
Other | Indirect | us-ph-lab-result-observation.value |
|
561
|
N. Discharge Summary | ||
|
562
|
Did the patient have any of the following diagnoses at discharge (check all that apply) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
563
|
No discharge summary available | Gap | |
|
564
|
Acute encephalopathy/Encephalitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
565
|
Acute liver failure | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
566
|
Acute Myocardial Infarction | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
567
|
Acute myocarditis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
568
|
Acute Renal Failure/Acute Kidney Inury | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
569
|
Acute Respiratory Distress Syndrome (ARDS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
570
|
Acute respiratory failure | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
571
|
Asthma exacerbation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
572
|
Bacteremia | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
573
|
Bronchiolitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
574
|
Bronchitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
575
|
Chronic lung disease of prematuriyy/BPD | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
576
|
Congestive Heart Failure (CHF) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
577
|
COPD exacerbation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
578
|
Deep Vein Thrombosis (DVT) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
579
|
Diabetic Ketoacidosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
580
|
Disseminated intravascular coagulation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
581
|
Guillain-Barre Syndrome (GBS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
582
|
Hemophagocytic Syndrome | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
583
|
Invasive pulmonary aspergillosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
584
|
Kawasaki disease | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
585
|
Mucormycosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
586
|
Multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
587
|
Other thrombosis/embolism/coagulopathy | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
588
|
Pneumonia | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
589
|
Pulmonary Embolism (PE) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
590
|
Reye's Syndrome | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
591
|
Rhabdomyolysis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
592
|
Sepsis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
593
|
Seizures | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
594
|
Stroke (CVA) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
595
|
Toxic Shock Syndrome (TSS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
596
|
O. ICD-10-CM codes Discharged Diagnoses | ||
|
597
|
ICD-10-CM codes available?) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
598
|
1, 2, 3, 4, 5, 6, 7, 8, 9 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
599
|
P. Pregnancy Information - To be completed for pregnant women only | ||
|
600
|
Total number of pregnancies at time of hospital admission (Gravida, G) | Indirect | us-ph-lab-result-observation.value WHERE code.text = gravida |
|
601
|
Total number of pregnancies at time of hospital admission unknown | Indirect | us-ph-lab-result-observation.value(Null) WHERE code.text = gravida |
|
602
|
Total number of pregnancies at time of hospital admission that resulted in a live birth | Indirect | us-ph-lab-result-observation.value WHERE code.text = parity |
|
603
|
Total number of pregnancies at time of hospital admission that resulted in a live birth Unknown | Indirect | us-ph-lab-result-observation.value WHERE code.text = parity |
|
604
|
Specify total number of fetuses for current pregnancy at time of hospital admission | Indirect | us-ph-lab-result-observation.value |
|
605
|
Specify gestational age in weeks at time of hospital admission | Gap | |
|
606
|
Gestational age in weeks at time of hospital admission unknown | Gap | |
|
607
|
If gestational age in weeks unknown, specify trimester of pregnancy: | Indirect | us-ph-lab-result-observation.value |
|
608
|
Pregnancy complications during current pregnancy? | Indirect | us-ph-lab-result-observation.value |
|
609
|
Indicate pregnancy status at discharge or death: | Indirect | us-ph-lab-result-observation.value |
|
610
|
If patient was pregnant on admission but no longer pregnant at discharge, indicate pregnancy outcome at discharge | Indirect | us-ph-lab-result-observation.value |
|
611
|
Pre-term live birth? (<37 weeks GA) | Indirect | us-ph-lab-result-observation.value |
|
612
|
Pre-term delivery, gestational age in weeks | Gap | |
|
613
|
If no longer pregnant, indicate date of delivery or end of pregnancy | Complete | us-ph-postpartum-status.effectiveDateTime |
|
614
|
If no longer pregnant, indicate date of delivery or end of pregnancy - unknown | Gap | |
|
615
|
If delivered, plurality at delivery: | Gap | |
|
616
|
If delivered, delivery type: | Gap | |
|
617
|
R. Vaccination History | ||
|
618
|
Vaccine Registry: Source Information | Gap | |
|
619
|
Vaccine Registry: Source Information - Source available but not reviewed (specify) | Gap | |
|
620
|
COVID-19 Vaccination Documentation | Gap | |
|
621
|
How many doses were received? | Complete | us-core-immunization.protocolApplied.doseNumber |
|
622
|
Dose 1,2,3 Date | Complete | us-core-immunization.occurrenceDateTime |
|
623
|
Dose 1,2,3 Date Month | Complete | us-core-immunization.occurrenceDateTime |
|
624
|
Dose 1,2,3 Date Month Unknown | Complete | us-core-immunization.occurrenceDateTime |
|
625
|
Dose 1,2,3 Date Day | Complete | us-core-immunization.occurrenceDateTime |
|
626
|
Dose 1,2,3 Date Day Unknown | Complete | us-core-immunization.occurrenceDateTime(NULL) |
|
627
|
Dose 1,2,3 Product Manufacturer | Complete | us-core-immunization.manufacturer.reference(Organization.name) |
|
628
|
Dose 1,2,3 Product Manufacturer Other, specify | Complete | us-core-immunization.manufacturer.reference(Organization.name) |
|
629
|
Dose 1,2,3 Product Name | Complete | us-core-immunization.vaccineCode.coding.display |
|
630
|
Dose 1,2,3 Product Name Other, specify | Complete | us-core-immunization.vaccineCode.coding.display |
|
631
|
Dose 1,2,3 Lot Number | Complete | us-core-immunization.lotNumber |
|
632
|
Dose 1,2,3 Lot Number Unknown | ||
|
633
|
O. Additional Comments | ||
|
634
|
Additional Comments | Gap | |
Hospital-based Surveillance for Respiratory Syncytial Virus (RSV): This use case focuses on collecting data similar to use case 2 but for patients who test positive for RSV. Public health surveillance through RSV-NET is conducted in many of the same sites as FluSurv-NET, collects many of the same data elements, with some additional data elements specific to these viral illnesses.
| A | B | C | |
|---|---|---|---|
|
1
|
Use Case 5 CRF Question | Mapping Fidelity | RESP-NET on FHIR IG Profile Mapping |
|
2
|
Header Information | ||
|
3
|
Case ID | Gap | |
|
4
|
COVID-NET CaseID | Gap | |
|
5
|
FluSurv-NET Case ID | Gap | |
|
6
|
A. Patient Data - THIS INFORMATION IS NOT SENT TO CDC | ||
|
7
|
Last Name | Complete | us-ph-patient.name |
|
8
|
First Name | Complete | us-ph-patient.name |
|
9
|
Middle Name | Complete | us-ph-patient.name |
|
10
|
Chart Number | Gap | |
|
11
|
Address | Complete | us-ph-patient.address.line |
|
12
|
Address Type | Gap | |
|
13
|
State | Complete | us-ph-patient.address.state |
|
14
|
City | Complete | us-ph-patient.address.city |
|
15
|
Zip | Complete | us-ph-patient.address.postalCode |
|
16
|
Site Use | Gap | Gap |
|
17
|
CDC Track | Gap | |
|
18
|
B. Abstractor Information - THIS INFORMATION IS NOT SENT TO CDC | ||
|
19
|
Abstractor Name | Gap | |
|
20
|
Date of Abstraction | Gap | |
|
21
|
C. Enrollment Information | ||
|
22
|
Admission Type | ||
|
23
|
State (residence of patient) | Complete | us-ph-patient.address.state |
|
24
|
County | Complete | us-ph-patient.address.district |
|
25
|
Case Type | Indirect | us-ph-patient.birthDate |
|
26
|
Date of Birth | Complete | us-ph-patient.birthDate |
|
27
|
Age | Indirect/Gap | Gap |
|
28
|
Age Units | Gap | Gap |
|
29
|
Sex | Complete | us-ph-patient.extension:birthsex |
|
30
|
Race | Partial | us-ph-patient.extension:race |
|
31
|
White | Indirect | us-ph-patient.extension:race(White) |
|
32
|
Black or African American | Indirect | us-ph-patient.extension:race(Black or African American) |
|
33
|
Asian | Indirect | us-ph-patient.extension:race(Asian) |
|
34
|
Native Hawaiian or Other Pacific Islander | Indirect | us-ph-patient.extension:race(Native Hawaiian or Other Pacific Islander) |
|
35
|
American Indian or Alaskan Native | Indirect | us-ph-patient.extension:race(American Indian or Alaska Native) |
|
36
|
Multiracial | Gap | |
|
37
|
Not Specified | Indirect | us-ph-patient.extension:race(Unknown) |
|
38
|
Ethnicity | Complete | us-ph-patient.extension:ethnicity |
|
39
|
Type of insurance | Partial | us-ph-encounter.account.coverage.type |
|
40
|
Private | Partial | us-ph-encounter.account.coverage.type |
|
41
|
Medicare | Partial | us-ph-encounter.account.coverage.type |
|
42
|
Medicaid | Partial | us-ph-encounter.account.coverage.type |
|
43
|
Military | Complete | us-ph-encounter.account.coverage.type |
|
44
|
Indian Health Service | Complete | us-ph-encounter.account.coverage.type |
|
45
|
Incarcerated | Gap | |
|
46
|
Uninsured | Gap | |
|
47
|
Unknown | Gap | |
|
48
|
Other | Gap | |
|
49
|
Other,specify | Gap | |
|
50
|
Pregnant? (15-49 years of age only) | Indirect | us-ph-pregnancy-status-observation.value |
|
51
|
Hospital ID where patient treated | Indirect | us-ph-organization.identifier |
|
52
|
Admission Date | Indirect | us-ph-encounter.period |
|
53
|
Discharge Date | Indirect | us-ph-encounter.period |
|
54
|
Was patient transferred from another hospital | Indirect | us-ph-encounter.hospitalization.admitSource = hosp-trans |
|
55
|
Transfer Hospital ID | Indirect | us-ph-organization.identifier |
|
56
|
Transfer Hospital Admission Date | Indirect | us-ph-encounter.period |
|
57
|
Transfer Date | Indirect | us-ph-encounter.period |
|
58
|
Where did patient reside at the time of hospitalization? Indicate TYPE of residence. | Partial | us-ph-characteristics-of-home-environment.value |
|
59
|
Other, specify | Gap | |
|
60
|
If resident of a facility, indicate NAME of facility: | Indirect | us-ph-organization.name |
|
61
|
D. RSV Testing Result (can add up to 4 test results in database) | ||
|
62
|
Test 1, Test 2 | Complete | us-ph-lab-result-observation.code |
|
63
|
Test Result 1, Test Result 2 | Complete | us-ph-lab-result-observation.value |
|
64
|
Specimen Collection Date 1, Specimen Collection Date 2 | Complete | us-ph-lab-result-observation.effectiveDateTime |
|
65
|
Testing Facility ID1, Testing Facility ID2 | Indirect | us-ph-lab-result-observation.performer.organization.identifier |
|
66
|
E. ICU and Other Interventions (can add up to 3 ICU stays in database) | ||
|
67
|
Was patient admitted to an intensive care unit (ICU)? | Indirect | us-ph-encounter.serviceType = intensive care medicine OR pediatric intensive care medicine |
|
68
|
Date of first ICU Admission | Indirect | us-ph-encounter.period.start |
|
69
|
Unknown | Indirect | us-ph-encounter.period.start(NULL) |
|
70
|
Date of first ICU Discharge | Indirect | us-ph-encounter.period.end |
|
71
|
Unknown | Indirect | us-ph-encounter.period.end(NULL) |
|
72
|
BiPAP or CPAP use? | Indirect | us-ph-lab-result-observation.device.type |
|
73
|
High flow nasal cannula (e.g. Vapotherm) | Indirect | us-ph-lab-result-observation.device.type |
|
74
|
Invasive Mechanical Ventilation | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
75
|
Extracorporeal Membrane Oxygenation (ECMO or 'on bypass') | Indirect | eicr-procedure.focalDevice.usedReference.Device.type |
|
76
|
Vasopressor use? | Indirect | eicr-procedure.code |
|
77
|
Renal Replacement Therapy (RRT) or dialysis? | Indirect | eicr-procedure.code |
|
78
|
F. Outcome | ||
|
79
|
What was the outcome of the patient upon discharge? | Indirect/Gap | us-ph-patient.deceasedDateTime OR us-ph-encounter.dischargeDisposition |
|
80
|
Date of death | us-ph-patient.deceasedDateTime | |
|
81
|
If discharge alive, please indicate to where | Partial | us-ph-encounter.hospitalization.dischargeDisposition OR us-ph-encounter.hospitalization.discharge.location.type |
|
82
|
Other, specify | Partial | us-ph-encounter.hospitalization.dischargeDisposition OR us-ph-encounter.hospitalization.discharge.location.type |
|
83
|
G. Admission and Patient History (complete ONLY if ICU or death) | ||
|
84
|
Reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition.code OR us-ph-encounter.reasonCode.code |
|
85
|
Specify other reason for admission | Indirect | us-ph-encounter.reasonReference.us-core-condition.code OR us-ph-encounter.reasonCode.code |
|
86
|
Acute signs/symptoms present at admission (began or worsened within 2 weeks prior to admission) (Select all that apply): | ||
|
87
|
None of the below signs/symptoms | Indirect | us-ph-condition.code(null) |
|
88
|
Abdominal pain | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
89
|
Altered mental status/confusion | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
90
|
Anosmia/decreased smell | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
91
|
Chest pain | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
92
|
Conjunctivitis/pink eye | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
93
|
Diarrhea | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
94
|
Dysgeusia/decreased taste | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
95
|
Fatigue/weakness | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
96
|
Fever/chills | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
97
|
Headache | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
98
|
Myalgia/musle aches | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
99
|
Nausea/vomiting | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
100
|
Rash | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
101
|
Seizures | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
102
|
Congested/runny nose | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
103
|
Cough | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
104
|
Hemoptysis/bloody sputum | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
105
|
Shortness of breath/respiratory distress | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
106
|
Sore throat | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
107
|
URI/ILI | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
108
|
Wheezing | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
109
|
Apnea | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
110
|
Cyanosis | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
111
|
Decreased vocalization/stridor | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
112
|
Dehydration | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
113
|
Hypothermia | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
114
|
Inability to eat/poor feeding | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
115
|
Lethargy | Indirect | us-ph-encounter.reasonReference.us-core-condition.code |
|
116
|
Date of onset of acute respiratory symptoms | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate |
|
117
|
Date of onset of acute respiratory symptoms Unknown | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate(null) |
|
118
|
Date of onset of acute respiratory symptoms Not Applicable | Complete | us-ph-encounter.reasonReference.us-core-condition.onsetDate(null) |
|
119
|
Height | Complete | us-core-vital-signs.valueQuantity WHERE code = 8302-2 Body height |
|
120
|
In or Cm | Complete | us-core-vital-signs.valueQuantity.unit |
|
121
|
Height Unknown | Complete | us-core-vital-signs.value(NULL) |
|
122
|
Weight | Complete | us-core-vital-signs.valueQuantity WHERE code = 29463-7 Body weight |
|
123
|
Lbs or KG | Complete | us-core-vital-signs.valueQuantity.unit |
|
124
|
Weight Unknown | Complete | us-core-vital-signs.value(NULL) WHERE code = 29463-7 Body weight |
|
125
|
Body Mass Index | Complete | us-core-vital-signs.valueQuantity WHERE code = 59576-9 OR 39156-5 |
|
126
|
Body Mass Index Unknown | Complete | us-core-vital-signs.value(NULL) WHERE code = 59576-9 OR 39156-5 |
|
127
|
Smoker (tobacco) | Partial | us-core-smokingstatus.value |
|
128
|
Alcohol abuse | Indirect | us-ph-lab-result-observation.value |
|
129
|
Substance abuse | Indirect | us-ph-lab-result-observation.value |
|
130
|
Substance Abuse Type (current use only) | Indirect | us-ph-lab-result-observation.value |
|
131
|
Intravenous drug use (IVDU) | Indirect | us-ph-lab-result-observation.value |
|
132
|
Polysubstance abuse - not otherwise specified | Indirect | us-ph-lab-result-observation.value |
|
133
|
Opioids | Indirect | us-ph-lab-result-observation.value |
|
134
|
Cocaine | Indirect | us-ph-lab-result-observation.value |
|
135
|
Methamphetamines | Indirect | us-ph-lab-result-observation.value |
|
136
|
Marijuana | Indirect | us-ph-lab-result-observation.value |
|
137
|
Other substance abuse | Indirect | us-ph-lab-result-observation.value |
|
138
|
Substance Type, specify | Indirect | us-ph-lab-result-observation.value |
|
139
|
Substance Type unknown | Indirect | us-ph-lab-result-observation.value |
|
140
|
Code status on admission | Gap | Gap |
|
141
|
H. Underlying Medical Conditions (complete ONLY if ICU or death) | ||
|
142
|
Did the patient have any of the following pre-existing conditions | Indirect | us-ph-condition.code |
|
143
|
Chronic lung disease | Indirect | us-ph-condition.code |
|
144
|
Active tuberculosis/TB | Indirect | us-ph-condition.code |
|
145
|
Asbestosis | Indirect | us-ph-condition.code |
|
146
|
Asthma/Reactive airway disease | Indirect | us-ph-condition.code |
|
147
|
Bronchiesctasis | Indirect | us-ph-condition.code |
|
148
|
Bronchiolitis obliterans | Indirect | us-ph-condition.code |
|
149
|
Chronic bronchitis | Indirect | us-ph-condition.code |
|
150
|
Chronic respiratory failure | Indirect | us-ph-condition.code |
|
151
|
Cystic fibrosis (CF) | Indirect | us-ph-condition.code |
|
152
|
Emphysema/Chronic obstructive pulmonary disease (COPD) | Indirect | us-ph-condition.code |
|
153
|
Interstitial lung disease (ILD) | Indirect | us-ph-condition.code |
|
154
|
Oxygen (O2) dependent | Indirect | us-ph-condition.code |
|
155
|
Obstructive sleep apnea (OSA) | Indirect | us-ph-condition.code |
|
156
|
Pulmonary fibrosis | Indirect | us-ph-condition.code |
|
157
|
Restrictive lung disease | Indirect | us-ph-condition.code |
|
158
|
Sarcoidosis | Indirect | us-ph-condition.code |
|
159
|
Chronic metabolic disease (including diabetes) | Indirect | us-ph-condition.code |
|
160
|
Adrenal disorders (Addison's, Adrenal Insufficiency, Cushing syndrome, Congenital adrenal hyperplasia) | Indirect | us-ph-condition.code |
|
161
|
Diabetes mellitus (DM) | Indirect | us-ph-condition.code |
|
162
|
Glycogen or other storage diseases (see list) | Indirect | us-ph-condition.code |
|
163
|
Hyper/Hypo function of pituitary gland | Indirect | us-ph-condition.code |
|
164
|
Inborn erros of metabolism (see list) | Indirect | us-ph-condition.code |
|
165
|
Metabolic syndrome | Indirect | us-ph-condition.code |
|
166
|
Parathyroid dysfunction (Hyperparathyroidism, Hypoparathyroidism) | Indirect | us-ph-condition.code |
|
167
|
Thyroid dysfunction (Grave's disease, Hashimoto's disease, Hyperthyroidism, Hypothyroidism) | Indirect | us-ph-condition.code |
|
168
|
Blood disorders/Hemoglobinopathy | Indirect | us-ph-condition.code |
|
169
|
Alpha thalassemia | Indirect | us-ph-condition.code |
|
170
|
Aplastic anemia | Indirect | us-ph-condition.code |
|
171
|
Beta thalassemia | Indirect | us-ph-condition.code |
|
172
|
Coagulopathy (Factor V Leiden, Von Willebrand Disease (VWD), see list) | Indirect | us-ph-condition.code |
|
173
|
Hemoglobin S-beta thalassemia | Indirect | us-ph-condition.code |
|
174
|
Leukopenia | Indirect | us-ph-condition.code |
|
175
|
Myelodysplastic syndrome (MDS) | Indirect | us-ph-condition.code |
|
176
|
Neutropenia | Indirect | us-ph-condition.code |
|
177
|
Pancytopenia | Indirect | us-ph-condition.code |
|
178
|
Polycythemia vera | Indirect | us-ph-condition.code |
|
179
|
Polycythemia vera (database only) | Indirect | us-ph-condition.code |
|
180
|
Sickle cell disease | Indirect | us-ph-condition.code |
|
181
|
Splenectomy/Asplenia | Indirect | us-ph-condition.code |
|
182
|
Thrombocytopenia | Indirect | us-ph-condition.code |
|
183
|
Cardiovascular disease | Indirect | us-ph-condition.code |
|
184
|
Aortic aneurysm (AAA), history of | Indirect | us-ph-condition.code |
|
185
|
Aortic/Mitral/Tricuspid/Pulmonic valve replacement, history of | Indirect | us-ph-condition.code |
|
186
|
Aortic regurgitation (AR) | Indirect | us-ph-condition.code |
|
187
|
Aortic stenosis (AS) | Indirect | us-ph-condition.code |
|
188
|
Atherosclerotic cardiovascular disease (ASCVD) | Indirect | us-ph-condition.code |
|
189
|
Atrial fibrillation (AFib) | Indirect | us-ph-condition.code |
|
190
|
Atrioventricular (AV) blocks | Indirect | us-ph-condition.code |
|
191
|
Automated implantable devices (AID/AICD)/Pacemaker | Indirect | us-ph-condition.code |
|
192
|
Bundle branch block (BBB/RBBB/LBBB) | Indirect | us-ph-condition.code |
|
193
|
Cardiomyopathy | Indirect | us-ph-condition.code |
|
194
|
Carotid stenosis | Indirect | us-ph-condition.code |
|
195
|
Cerebral vascular accident (CVA)/Incident/Stroke, history of | Indirect | us-ph-condition.code |
|
196
|
Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
197
|
Atrial septal defect | Indirect | us-ph-condition.code |
|
198
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
199
|
Tetralogy of fallot | Indirect | us-ph-condition.code |
|
200
|
Ventricular septal defect | Indirect | us-ph-condition.code |
|
201
|
Other congenital heart disease, specify | Indirect | us-ph-condition.code |
|
202
|
Other Congenital heart disease (specify) | Indirect | us-ph-condition.code |
|
203
|
Coronary artery bypass grafting (CABG), history of | Indirect | us-ph-condition.code |
|
204
|
Coronary artery disease (CAD) | Indirect | us-ph-condition.code |
|
205
|
Deep vein thrombosis (DVT), history of | Indirect | us-ph-condition.code |
|
206
|
Heart failure/Congenital heart failure (CHF) | Indirect | us-ph-condition.code |
|
207
|
Myocardial infarction (MI), history of | Indirect | us-ph-condition.code |
|
208
|
Mitral regurgitation (MR) | Indirect | us-ph-condition.code |
|
209
|
Mitral stenosis (MS) | Indirect | us-ph-condition.code |
|
210
|
Peripheral artery disease (PAD) | Indirect | us-ph-condition.code |
|
211
|
Peripheral vascular disease (PVD) | Indirect | us-ph-condition.code |
|
212
|
Pulmonary embolism (PE), history of | Indirect | us-ph-condition.code |
|
213
|
Pulmonary hypertension (PHTN) | Indirect | us-ph-condition.code |
|
214
|
Pulmonic regurgitation | Indirect | us-ph-condition.code |
|
215
|
Pulmonic stenosis | Indirect | us-ph-condition.code |
|
216
|
Transient ischemic attack (TIA), history of | Indirect | us-ph-condition.code |
|
217
|
Tricuspid regurgitation (TR) | Indirect | us-ph-condition.code |
|
218
|
Tricuspid stenosis | Indirect | us-ph-condition.code |
|
219
|
Ventricular fibrillation (VF, VFib), history of | Indirect | us-ph-condition.code |
|
220
|
Ventricular tachycardia (VT, VTach), history of | Indirect | us-ph-condition.code |
|
221
|
Valvular disorder not otherwise specified: | Indirect | us-ph-condition.code |
|
222
|
Neurologic disorders | Indirect | us-ph-condition.code |
|
223
|
Amyotrophic lateral sclerosis (ALS) | Indirect | us-ph-condition.code |
|
224
|
Cerebral palsy | Indirect | us-ph-condition.code |
|
225
|
Cognitive dysfunction | Indirect | us-ph-condition.code |
|
226
|
Dementia/Alzheimer's disease | Indirect | us-ph-condition.code |
|
227
|
Developmental delay | Indirect | us-ph-condition.code |
|
228
|
Down syndrome/Trisomy 21 | Indirect | us-ph-condition.code |
|
229
|
Edwards syndrome/Trisomy 18 | Indirect | us-ph-condition.code |
|
230
|
Epilepsy/Seizure/Seizure disorder | Indirect | us-ph-condition.code |
|
231
|
Mitochondiral disorder | Indirect | us-ph-condition.code |
|
232
|
Multiple sclerosis (MS) | Indirect | us-ph-condition.code |
|
233
|
Muscular dystrophy (see list) | Indirect | us-ph-condition.code |
|
234
|
Myasthenia gravis (MG) | Indirect | us-ph-condition.code |
|
235
|
Neural tube defects/Spina bifida (see list) | Indirect | us-ph-condition.code |
|
236
|
Neuropathy | Indirect | us-ph-condition.code |
|
237
|
Parkinson's disease | Indirect | us-ph-condition.code |
|
238
|
Plegias/Paralysis/Quadriplegia | Indirect | us-ph-condition.code |
|
239
|
Scoliosis/Kyphoscholiosis | Indirect | us-ph-condition.code |
|
240
|
Traumatic brain injury (TBI), history of | Indirect | us-ph-condition.code |
|
241
|
History of Guillain-Barre syndrome | Indirect | us-ph-condition.code |
|
242
|
Immunocompromised condition | Indirect | us-ph-condition.code |
|
243
|
AIDS or CD4 count < 200 | Indirect | us-ph-condition.code |
|
244
|
Complement deficiency (see list) | Indirect | us-ph-condition.code |
|
245
|
Grafts vs. Host disease (GVHD) | Indirect | us-ph-condition.code |
|
246
|
HIV infection | Indirect | us-ph-condition.code |
|
247
|
Immunoglobulin deficiency/Immunodeficiency (see list) | Indirect | us-ph-condition.code |
|
248
|
Immunosuppressive therapy (within the last 12 months of admission) (see list) | Indirect | us-ph-condition.code |
|
249
|
If yes, for what condition? | Indirect | us-ph-condition.code |
|
250
|
Leukemia* | Indirect | us-ph-condition.code |
|
251
|
Lymphoma/Hodgkins/Non-Hodgkins (NHL)* | Indirect | us-ph-condition.code |
|
252
|
Metastatic cancer* | Indirect | us-ph-condition.code |
|
253
|
Multiple myeloma* | Indirect | us-ph-condition.code |
|
254
|
Solid organ malignancy* | Indirect | us-core-condition-problems-health-concerns |
|
255
|
If yes, which organ? | Indirect | us-ph-condition.bodySite |
|
256
|
Steroid therapy (within 2 weeks of admission) | Indirect | us-ph-condition.code |
|
257
|
Transplant, hematopoietic stem cell (Bone marrow transplant BMT), Peripheral stem cell transplant (PSCT), history of | Indirect | us-ph-condition.code |
|
258
|
Transplant, solid organ (SOT), history of | Indirect | us-ph-condition.code |
|
259
|
Any obesity | Indirect | us-ph-condition.code |
|
260
|
Severely/morbidly obese | Indirect | us-ph-condition.code |
|
261
|
Obese | Indirect | us-ph-condition.code |
|
262
|
Post-partum (two weeks or less) | Indirect | us-ph-condition.code |
|
263
|
Renal disease | Indirect | us-ph-condition.code |
|
264
|
Chronic kidney disease (CKD)/Chronic renal insufficiency (CRI) | Indirect | us-ph-condition.code |
|
265
|
End-stage renal disease/Dialysis (ESRD) | Indirect | us-ph-condition.code |
|
266
|
Dialysis (HD) | Indirect | us-ph-condition.code |
|
267
|
Glomerulonephritis (GN) | Indirect | us-ph-condition.code |
|
268
|
Nephrotic syndrome | Indirect | us-ph-condition.code |
|
269
|
Polycystic kidney disease (PCKD) | Indirect | us-ph-condition.code |
|
270
|
Gastrointestinal/Liver Disease (Do not record GERD) | Indirect | us-ph-condition.code |
|
271
|
Alcoholic hepatitis | Indirect | us-ph-condition.code |
|
272
|
Autoimmune hepatitis | Indirect | us-ph-condition.code |
|
273
|
Barrett's esophagitis | Indirect | us-ph-condition.code |
|
274
|
Chronic liver disease | Indirect | us-ph-condition.code |
|
275
|
Chronic pancreatitis | Indirect | us-ph-condition.code |
|
276
|
Cirrhosis/End stage liver disease (ESLD) | Indirect | us-ph-condition.code |
|
277
|
Crohn's disease | Indirect | us-ph-condition.code |
|
278
|
Esophageal strictures | Indirect | us-ph-condition.code |
|
279
|
Esophageal varices | Indirect | us-ph-condition.code |
|
280
|
Hepatitis B, chronic (HBV) | Indirect | us-ph-condition.code |
|
281
|
Hepatitis C, chronic (HCV) | Indirect | us-ph-condition.code |
|
282
|
Non-alcoholic fatty liver disease/NASH/NAFLD | Indirect | us-ph-condition.code |
|
283
|
Ulcerative colitis (UC) | Indirect | us-ph-condition.code |
|
284
|
Rheumatologic/Autoimmune/Inflammatory Conditions (Do not record Osteoarthritis/OA) | Indirect | us-ph-condition.code |
|
285
|
Ankylosing spondylitis | Indirect | us-ph-condition.code |
|
286
|
Dermatomyositis | Indirect | us-ph-condition.code |
|
287
|
Juvenile idiopathic arthritis | Indirect | us-ph-condition.code |
|
288
|
Kawasaki disease | Indirect | us-ph-condition.code |
|
289
|
Microscopic polyangiitis | Indirect | us-ph-condition.code |
|
290
|
Polyarteritis nodosum (PAN) | Indirect | us-ph-condition.code |
|
291
|
Polymyalgia rheumatica | Indirect | us-ph-condition.code |
|
292
|
Polymyositis | Indirect | us-ph-condition.code |
|
293
|
Psoriatic arthritis | Indirect | us-ph-condition.code |
|
294
|
Rheumatoid arthritis (RA) | Indirect | us-ph-condition.code |
|
295
|
Systemic Lupus erythematosus/SLE/Lupus | Indirect | us-ph-condition.code |
|
296
|
Systemic sclerosis | Indirect | us-ph-condition.code |
|
297
|
Takaysu arteritis | Indirect | us-ph-condition.code |
|
298
|
Temporal/Giant cell arteritis | Indirect | us-ph-condition.code |
|
299
|
Vasculitis, other (see list) | Indirect | us-ph-condition.code |
|
300
|
Other | Indirect | us-ph-condition.code |
|
301
|
Hyertension | Indirect | us-ph-condition.code |
|
302
|
Feeding tube (PEG, see list) | Indirect | us-ph-condition.code |
|
303
|
Trach dependent/Vent dependent | Indirect | us-ph-condition.code |
|
304
|
Wheelchair dependent | Indirect | us-ph-condition.code |
|
305
|
Other | Indirect | us-ph-condition.code |
|
306
|
Other, specify | Indirect | us-ph-condition.code |
|
307
|
Abnormality of upper airway (see instructions) | Indirect | us-ph-condition.code |
|
308
|
Chronic lung disease of prematurity/Bronchopulmonary dysplasia (BPD) | Indirect | us-ph-condition.code |
|
309
|
History of febrile seizures | Indirect | us-ph-condition.code |
|
310
|
Long-term aspirin therapy | Indirect | us-ph-condition.code |
|
311
|
Premature (gestation age <37weeks at birth for patients <2 yrs) | Indirect | us-ph-condition.code |
|
312
|
Gestation age at birth in weeks | Gap | |
|
313
|
Unknown gestational age at birth | Indirect | us-ph-condition.code |
|
314
|
I. Bacterial Pathogens - Sterile site only (complete ONLY if ICU or death) | ||
|
315
|
Were any culture tests performed within 7 days of admission? | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
316
|
If yes, was there a positive culture for aspergillus, mucormycosis, or a bacterial pathogen? | ||
|
317
|
If yes, specify Pathogen 1, 2: | Complete | us-ph-lab-result-observation.vaue |
|
318
|
If yes, specify Pathogen 1, 2: Other | ||
|
319
|
Date of culture | Complete | us-ph-lab-result-observation.specimen.collectedDateTime |
|
320
|
Site where pathogen identified: | ||
|
321
|
Site where pathogen identified: Other, specify | ||
|
322
|
If Staphylococcus aureus, specify | ||
|
323
|
J. Viral Pathogens (complete ONLY if ICU or death) | ||
|
324
|
Was patient tested for any of the following viral respiratory pathogens within 14 days prior to or within 7 days of admission? | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
325
|
Flu A | Indirect | us-ph-lab-result-observation.value |
|
326
|
Flu A Type | Indirect | us-ph-lab-result-observation.value |
|
327
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
328
|
Flu B | Indirect | us-ph-lab-result-observation.value |
|
329
|
Flu B Type | Indirect | us-ph-lab-result-observation.value |
|
330
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
331
|
Flu (no subype specified) | Indirect | us-ph-lab-result-observation.value |
|
332
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
333
|
Adenovirus | Indirect | us-ph-lab-result-observation.value |
|
334
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
335
|
Parainfluenza 1, Parainfluenza 2, Parainfluenza 3, Parainfluenza 4 | Indirect | us-ph-lab-result-observation.value |
|
336
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
337
|
Human metapneumovirus | Indirect | us-ph-lab-result-observation.value |
|
338
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
339
|
Rhinovirus/Enterovirus | Indirect | us-ph-lab-result-observation.value |
|
340
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
341
|
Coronavirus 229E | Indirect | us-ph-lab-result-observation.value |
|
342
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
343
|
Coronavirus HKU1 | Indirect | us-ph-lab-result-observation.value |
|
344
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
345
|
Coronavirus NL63 | Indirect | us-ph-lab-result-observation.value |
|
346
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
347
|
Coronavirus OC43 | Indirect | us-ph-lab-result-observation.value |
|
348
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
349
|
Coronavirus (no subtype specified) | Indirect | us-ph-lab-result-observation.value |
|
350
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
351
|
SARS-CoV-2 Coronavirus: | Indirect | us-ph-lab-result-observation.value |
|
352
|
Date | Indirect | us-ph-lab-result-observation.effectiveDateTime |
|
353
|
K. RSV Treatment (complete ONLY if ICU or death) | ||
|
354
|
Did the patient receive ribavirin or an RSV antiviral treatment during the course of this illness? | Indirect | us-ph-medicationadministration.medication = antiviral medication for influenza |
|
355
|
Treatment: | ||
|
356
|
Treatment: Other, specify | ||
|
357
|
Start date: | ||
|
358
|
Start date: Unknown | ||
|
359
|
End date: | ||
|
360
|
End date: Unknown | ||
|
361
|
For pediatric cases <2 years: Did the patient receive palivizumab (Synagis) for the current RSV season? | ||
|
362
|
L. Discharge Summary (complete ONLY if ICU or death) | ||
|
363
|
Did the patient have any of the following diagnoses at discharge (check all that apply) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
364
|
No discharge summary available | Gap | Gap |
|
365
|
Acute encephalopathy/Encephalitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
366
|
Acute liver failure | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
367
|
Acute Myocardial Infarction | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
368
|
Acute myocarditis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
369
|
Acute Renal Failure/Acute Kidney Inury | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
370
|
Acute Respiratory Distress Syndrome (ARDS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
371
|
Acute respiratory failure | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
372
|
Asthma exacerbation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
373
|
Bacteremia | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
374
|
Bronchiolitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
375
|
Bronchitis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
376
|
Chronic lung disease of prematuriyy/BPD | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
377
|
Congestive Heart Failure (CHF) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
378
|
COPD exacerbation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
379
|
Deep Vein Thrombosis (DVT) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
380
|
Diabetic Ketoacidosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
381
|
Disseminated intravascular coagulation | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
382
|
Guillain-Barre Syndrome (GBS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
383
|
Hemophagocytic Syndrome | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
384
|
Invasive pulmonary aspergillosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
385
|
Kawasaki disease | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
386
|
Mucormycosis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
387
|
Multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
388
|
Other thrombosis/embolism/coagulopathy | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
389
|
Pneumonia | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
390
|
Pulmonary Embolism (PE) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
391
|
Reye's Syndrome | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
392
|
Rhabdomyolysis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
393
|
Sepsis | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
394
|
Seizures | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
395
|
Stroke (CVA) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
396
|
Toxic Shock Syndrome (TSS) | Complete | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
397
|
M. ICD-10-CM Discharge Diagnoses (to be recorded in order of appearance) | ||
|
398
|
ICD-10-CM codes available?) | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
399
|
1, 2, 3, 4, 5, 6, 7, 8, 9 | Indirect | us-ph-encounter.diagnosis.condition.code WHERE use = Discharge Diagnosis (DD) |
|
400
|
N. Pregnancy Information - To be completed for pregnant women only | ||
|
401
|
Total number of pregnancies at time of hospital admission (Gravida, G) | Indirect | us-ph-lab-result-observation.value WHERE code.text = gravida |
|
402
|
Total number of pregnancies at time of hospital admission unknown | Indirect | us-ph-lab-result-observation.value(Null) WHERE code.text = gravida |
|
403
|
Total # of pregnancies to date that resulted in a live birth as of date of admission (Parity, P): | Indirect | us-ph-lab-result-observation.value WHERE code.text = parity |
|
404
|
Total # of pregnancies to date that resulted in a live birth as of date of admission (Parity, P): Unknown | Indirect | us-ph-lab-result-observation.value |
|
405
|
Specify total # of fetuses for current pregnancy as of date of admission | Indirect | us-ph-lab-result-observation.value |
|
406
|
Specify gestational age in weeks as of date of admission: | Gap | |
|
407
|
Specify gestational age in weeks as of date of admission: unknown | Gap | |
|
408
|
If gestational age in weeks unknown, specify trimester of pregnancy: | Indirect | us-ph-lab-result-observation.value |
|
409
|
Pregnancy complications during current pregnancy? | Indirect | us-ph-lab-result-observation.value |
|
410
|
Indicate pregnancy status at discharge or death: | Indirect | us-ph-pregnancy-outcome-observation. |
|
411
|
If patient was pregnant on admission but no longer pregnant at discharge, indicate pregnancy outcome at discharge | Indirect | us-ph-pregnancy-outcome-observation. |
|
412
|
Pre-term live birth? (<37 weeks GA) | Indirect | us-ph-lab-result-observation.value |
|
413
|
Pre-term delivery, gestational age in weeks | Gap | |
|
414
|
If no longer pregnant, indicate date of delivery or end of pregnancy | Indirect | us-ph-pregnancy-outcome-observation.effectiveDate |
|
415
|
If no longer pregnant, indicate date of delivery or end of pregnancy - unknown | Indirect | us-ph-pregnancy-outcome-observation.effectiveDate(NULL) |
|
416
|
If delivered, plurality at delivery: | ||
|
417
|
If delivered, delivery type: | ||
|
418
|
O. Additional Comments | ||
|
419
|
Additional Comments | Gap | |
Each mapping table contains three columns. The left column contains the name of data element from each use case CRF. The right column contains the mapping to FHIR profile.element. The middle column designates the mapping fidelity. The mapping fidelity values and their descriptions are as follows:
IG © 2023+ HL7 International / Public Health. Package hl7.fhir.us.resp-net#1.0.0 based on FHIR 4.0.1. Generated 2025-05-02
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