{
  "description": "This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Denominator for Procedure. This report records datea on each patient having one of the NHSN procedures selected for monitoring.",
  "_filename": "Questionnaire-hai-questionnaire-opc-proc-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": "1",
    "lastUpdated": "2019-03-13T23:50:43.000-04:00"
  },
  "publisher": "HL7",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "hai-questionnaire-opc-proc-denom",
  "item": [ {
    "text": "Facility ID",
    "type": "url",
    "linkId": "facility-id",
    "repeats": false,
    "required": true
  }, {
    "text": "Event Number",
    "type": "url",
    "linkId": "event-number",
    "repeats": false,
    "required": true
  }, {
    "text": "Date of encounter",
    "type": "date",
    "linkId": "encounter-date",
    "repeats": false,
    "required": true
  }, {
    "code": [ {
      "code": "51898-5",
      "system": "http://loinc.org",
      "display": "Risk factors Document"
    } ],
    "item": [ {
      "code": [ {
        "code": "420089007",
        "system": "http://snomed.info/sct",
        "display": "CDC wound classification category"
      } ],
      "text": "Risk Factor: Wound class",
      "type": "choice",
      "linkId": "risk-factor-wound-class",
      "options": {
        "reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.9"
      },
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "423827005",
        "system": "http://snomed.info/sct",
        "display": "Endoscopy"
      } ],
      "text": "Risk Factor: Endoscopy used",
      "type": "boolean",
      "linkId": "risk-factor-endoscopy",
      "repeats": false,
      "required": true
    }, {
      "code": [ {
        "code": "73211009",
        "system": "http://snomed.info/sct",
        "display": "Diabetes mellitus"
      } ],
      "text": "Risk Factor: Diabetes mellitus",
      "type": "boolean",
      "linkId": "risk-factor-diabetes-mellitus",
      "repeats": false,
      "required": true
    }, {
      "code": [ {
        "code": "50373000",
        "system": "http://snomed.info/sct",
        "display": "Body Height"
      } ],
      "text": "Risk Factor: height",
      "type": "quantity",
      "linkId": "risk-factor-height",
      "repeats": false,
      "required": true
    }, {
      "code": [ {
        "code": "27113001",
        "system": "http://snomed.info/sct",
        "display": "Body Weight"
      } ],
      "text": "Risk Factor: height",
      "type": "quantity",
      "linkId": "risk-factor-weight",
      "repeats": false,
      "required": true
    }, {
      "code": [ {
        "code": "273270000",
        "system": "http://snomed.info/sct",
        "display": "American Society of Anesthesiologists physical status classification (assessment scale)"
      } ],
      "text": "Risk Factor: ASA Class",
      "type": "choice",
      "linkId": "risk-factor-asa-class",
      "options": {
        "reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.10"
      },
      "repeats": false,
      "required": true
    } ],
    "text": "Risk Factors",
    "type": "group",
    "linkId": "risk-factors",
    "repeats": false
  }, {
    "code": [ {
      "code": "51899-3",
      "system": "http://loinc.org",
      "display": "Details Document"
    } ],
    "item": [ {
      "text": "NHSN Procedure Code Category",
      "type": "choice",
      "linkId": "nhsn-procedure-code-category",
      "options": {
        "reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34"
      },
      "repeats": false,
      "required": true
    }, {
      "text": "CPT Procedure Code",
      "type": "choice",
      "linkId": "cpt-procedure-code",
      "repeats": false,
      "required": true
    }, {
      "text": "Procedure duration",
      "type": "quantity",
      "linkId": "procedure-duration",
      "repeats": false,
      "required": true
    } ],
    "text": "Procedure Details",
    "type": "group",
    "linkId": "procedure-details",
    "repeats": false
  }, {
    "text": "General anesthesia",
    "type": "boolean",
    "linkId": "general-anesthesia",
    "repeats": false,
    "required": true
  }, {
    "text": "Surgeon code",
    "type": "url",
    "linkId": "surgeon-code",
    "repeats": false,
    "required": true
  }, {
    "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": "Outpatient Procedure Component Denominator for Procedure",
  "package_version": "1.1.0",
  "status": "draft",
  "language": "en-US",
  "id": "21acf769-66c1-47f0-862f-e66f985c1823",
  "kind": null,
  "url": "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-proc-denom",
  "code": [ {
    "code": "51897-7",
    "system": "http://loinc.org",
    "display": "Healthcare Associated Infection report Document"
  } ],
  "identifier": [ {
    "value": "hai-questionnaire-opc-proc-denom-v1"
  } ],
  "version": "R1"
}