Clinical Quality Framework Common FHIR Assets (US-Based)
0.1.0 - CI Build United States of America (USA)

Clinical Quality Framework Common FHIR Assets (US-Based), published by Clinical Quality Framework. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cqf-us/ and changes regularly. See the Directory of published versions

Questionnaire: Medical Necessity For Authorization Of Catheters (Experimental)

Official URL: http://fhir.org/guides/cqf/us/common/Questionnaire/MNACQuestionnaire Version: 0.1.0
Active as of 2024-01-17 Computable Name: MNACQuestionnaire

The Health Care Authority requires this form for all clients requesting sterile closed catheter.

Generated Narrative: Questionnaire MNACQuestionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. MNACQuestionnaireThe Health Care Authority requires this form for all clients requesting sterile closed catheter.Questionnairehttp://fhir.org/guides/cqf/us/common/Questionnaire/MNACQuestionnaire#0.1.0
... request-infoRequest Information0..1group
.... request-info|date-of-requestDATE OF REQUEST0..1date
... diagnosis-infoDiagnosis Information0..1group
.... diagnosis-info|diagnosisDiagnosis0..1string
... item-requestedItem Requested0..1group
.... item-requested|itemItem requested0..1string
... uti-historyUTI History0..1group
.... uti-history|uti-last-yearThe patient has|had documented recurrent urinary tract infections while on a program of clean cathing, twice within a 12 month period prior to beginning sterile cathing0..1choiceOptions: 2 options
.... uti-history|uti-datesDates of UTIs in the last year0..1stringEnable When: uti-history|uti-last-year =
.... uti-history|antibiotics-usedAntibiotics used for UTIs in the last year0..1stringEnable When: uti-history|uti-last-year =
... symptoms-infoSymptoms Information0..1group
.... symptoms-info|symptomsCheck those that apply to your patient0..*choiceOptions: 7 options
.... symptoms-info|fever-temperatureIf fever, state temperature in degrees0..1decimalEnable When: symptoms-info|symptoms =
... catheterization-frequencyCatheterization Frequency0..1group
.... catheterization-frequency|frequencyHow many times per day does the patient catheterize?0..1choiceOptions: 4 options
... additional-commentsAdditional Comments0..1group
.... additional-comments|commentsAdditional Comment0..1string
... physician-infoPhysician Information0..1group
.... physician-info|namePhysician's Name0..1string
.... physician-info|mobileTelephone0..1string
.... physician-info|faxFAX0..1string
.... physician-info|signaturePhysician's Signature0..1attachment
.... physician-info|phone-referringReferring Physician Telephone0..1string
.... physician-info|dateDate0..1string

doco Documentation for this format

Options Sets

Answer options for uti-history|uti-last-year

  • null#Yes ("Yes")
  • null#No ("No")

Answer options for symptoms-info|symptoms

  • null#Fever ("Fever; state temperature in degree")
  • null#UrinaryUrgencyFrequency ("Change in urinary urgency, frequency, or incontinence")
  • null#AutonomicDysreflexia ("Appearance of new or increase in autonomic dysreflexia")
  • null#PhysicalSignsProstatitis ("Physical signs of prostatitis, epididymitis, orchitis")
  • null#Immunosuppressed ("The patient is immunosuppressed")
  • null#Pyuria ("Pyuria")
  • null#SystemicLeukocytosis ("Systemic leukocytosis")

Answer options for catheterization-frequency|frequency

  • null#2-4Times ("2-4 times")
  • null#4-6Times ("4-6 times")
  • null#6-8Times ("6-8 times")
  • null#8TimesOrMore ("8 times or more")