{
  "description": "This Questionnaire instance defines the questions and possible answers in the Late Onset Sepsis/Meningitis Event (LOS) Denominator. This report records the denominator information for neonatal component late onset sepsis and meningitis (LOS/Men).",
  "_filename": "Questionnaire-hai-questionnaire-los-denom.json",
  "package_name": "hl7.fhir.us.hai",
  "subjectType": [ "Patient" ],
  "date": "2019-04-01",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire" ],
    "versionId": "5",
    "lastUpdated": "2019-03-13T21:32:00.000-04:00"
  },
  "publisher": "HL7",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "hai-questionnaire-los-denom",
  "item": [ {
    "text": "Year and month data collected for this location",
    "type": "date",
    "linkId": "date-collected",
    "repeats": false,
    "required": true
  }, {
    "text": "Facility ID",
    "type": "url",
    "linkId": "facility",
    "repeats": false,
    "required": true
  }, {
    "text": "Date Admitted to Facility",
    "type": "date",
    "linkId": "date-admitted-to-facility",
    "repeats": false,
    "required": true
  }, {
    "code": [ {
      "code": "46240-8",
      "system": "http://loinc.org",
      "display": "History of Hospitalizations+Outpatient visits Narrative"
    } ],
    "item": [ {
      "text": "Facility Location Type",
      "type": "choice",
      "linkId": "facility-location-type",
      "options": {
        "reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.19"
      },
      "repeats": false,
      "required": true
    }, {
      "text": "Facility Location",
      "type": "url",
      "linkId": "facility-location",
      "repeats": false,
      "required": true
    }, {
      "text": "Date admitted or transferred to location",
      "type": "date",
      "linkId": "location-admit-transfer-date",
      "repeats": false,
      "required": true
    }, {
      "text": "Disposition of infant",
      "type": "choice",
      "linkId": "infant-disposition",
      "options": {
        "reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.30"
      },
      "repeats": false,
      "required": true
    }, {
      "text": "Disposition date if discharged, transferred, or expired",
      "type": "date",
      "linkId": "disposition-date",
      "repeats": false,
      "required": false,
      "enableWhen": [ {
        "question": "infant-disposition",
        "answerCoding": {
          "code": "183665006",
          "system": "http://snomed.info/sct"
        }
      }, {
        "question": "infant-disposition",
        "answerCoding": {
          "code": "266751003",
          "system": "http://snomed.info/sct"
        }
      }, {
        "question": "infant-disposition",
        "answerCoding": {
          "code": "371828006",
          "system": "http://snomed.info/sct"
        }
      } ]
    } ],
    "text": "Location Within Facility Encounter",
    "type": "group",
    "linkId": "location-within-facility-encounter-group",
    "repeats": false
  }, {
    "code": [ {
      "code": "51898-5",
      "system": "http://loinc.org",
      "display": "Risk factors Document"
    } ],
    "item": [ {
      "code": [ {
        "code": "364589006",
        "system": "http://snomed.info/sct",
        "display": "Birth Weight"
      } ],
      "text": "Risk Factor: Birth weight (grams)",
      "type": "quantity",
      "linkId": "risk-factor-birth-weight",
      "repeats": false,
      "required": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
        "valueCoding": {
          "code": "g",
          "system": "http://unitsofmeasure.org",
          "display": "g"
        }
      } ]
    }, {
      "code": [ {
        "code": "76516-4",
        "system": "http://loinc.org",
        "display": "Gestational age--at birth"
      } ],
      "text": "Risk Factor: Gestational age (days)",
      "type": "quantity",
      "linkId": "risk-factor-gestational-age",
      "repeats": false,
      "required": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
        "valueCoding": {
          "code": "d",
          "system": "http://unitsofmeasure.org",
          "display": "d"
        }
      } ]
    } ],
    "text": "Risk Factors: Contains birth weight and gestational age",
    "type": "group",
    "linkId": "risk-factors",
    "repeats": false
  }, {
    "code": [ {
      "code": "86468-6",
      "system": "http://www.loinc.org",
      "display": "Report Comment Section"
    } ],
    "text": "Comments",
    "type": "text",
    "linkId": "nhsn-comment",
    "repeats": false,
    "required": false,
    "maxLength": 2000
  } ],
  "type": null,
  "experimental": "false",
  "resourceType": "Questionnaire",
  "title": "Late Onset Sepsis/Meningitis Denominator",
  "package_version": "1.1.0",
  "status": "draft",
  "language": "en-US",
  "id": "18c5ac03-8b04-4d01-8ca8-3dc6bef8740b",
  "kind": null,
  "url": "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-los-denom",
  "code": [ {
    "code": "51897-7",
    "system": "http://loinc.org",
    "display": "Healthcare Associated Infection report Document"
  } ],
  "identifier": [ {
    "value": "hai-questionnaire-los-denom-v1"
  } ],
  "version": "R1"
}