{
"description": "This Questionnaire instance defines the questions and possible answers in the MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF. It records the monthly aggregate data for Multi-Drug Resistant Organisms (MDRO) and Clostridium difficile (C. diff, CDI).",
"_filename": "Questionnaire-hai-ltcf-questionnaire-mdro-cdi-summary.json",
"package_name": "hl7.fhir.us.hai-ltcf",
"subjectType": [ "Group" ],
"date": "2019-08-01",
"meta": {
"versionId": "2",
"lastUpdated": "2019-07-05T01:19:42.000-04:00"
},
"publisher": "HL7",
"jurisdiction": [ {
"coding": [ {
"code": "US",
"system": "urn:iso:std:iso:3166"
} ]
} ],
"name": "HAI_LTCF_questionnaire_mdro_cdi_summary",
"item": [ {
"text": "Facility ID",
"type": "url",
"linkId": "facility-id",
"repeats": false,
"required": true
}, {
"text": "First Day of Period Reported",
"type": "date",
"linkId": "report-period-start",
"repeats": false,
"required": true
}, {
"text": "Last Day of Period Reported",
"type": "date",
"linkId": "report-period-end",
"repeats": false,
"required": true
}, {
"text": "Facility Location Code",
"type": "choice",
"linkId": "facility-location-code",
"repeats": false,
"required": true,
"answerValueSet": "http://hl7.org/fhir/us/hai-ltcf/ValueSet/2.16.840.1.113883.13.19"
}, {
"code": [ {
"code": "51900-9",
"system": "http://loinc.org",
"display": "Population Summary note"
} ],
"item": [ {
"text": "The Summary Data Group a set of summary data for a population in the defined NHSN protocol.",
"type": "display",
"linkId": "summary-data-group-display"
}, {
"code": [ {
"code": "1369-8",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Resident days"
} ],
"text": "Resident Days",
"type": "integer",
"linkId": "resident-days",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1370-6",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Resident admissions"
} ],
"text": "Resident Admissions",
"type": "integer",
"linkId": "resident-admissions",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1371-4",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Number of admissions on C. diff treatment"
} ],
"text": "Number of Admissions on C. diff Treatment",
"type": "integer",
"linkId": "number-admissions-on-c-diff-treatment",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1372-2",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Number of residents started on antibiotic treatment for C. diff"
} ],
"text": "Number of C. diff Treatment Starts",
"type": "integer",
"linkId": "number-c-diff-treatment-starts",
"repeats": false,
"required": true
} ],
"text": "Summary Data Group",
"type": "group",
"linkId": "summary-data-group",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "90252-8",
"system": "http://loinc.org",
"display": "Report no events"
} ],
"item": [ {
"text": "The Report No Events Group contains statements that there are no events to report for a particular type of event.",
"type": "display",
"linkId": "report-no-events-group-display"
}, {
"code": [ {
"code": "3030-4",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus"
} ],
"text": "Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus",
"type": "boolean",
"linkId": "no-lab-id-event-mrsa",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "1307-8",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus"
} ],
"text": "Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus",
"type": "boolean",
"linkId": "no-lab-id-event-mssa",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3033-8",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - Vancomycin resistant Enterococcus"
} ],
"text": "Report no labID event - All specimens - Vancomycin resistant Enterococcus",
"type": "boolean",
"linkId": "no-lab-id-event-vre",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3036-1",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - CephR Klebsiella"
} ],
"text": "Report no labID event - All specimens - CephR Klebsiella",
"type": "boolean",
"linkId": "no-lab-id-event-cephr-klebsiella",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3039-5",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - CRE E. coli"
} ],
"text": "Report no labID event - All specimens - CRE E. coli",
"type": "boolean",
"linkId": "no-lab-id-event-mrsa-cre-e-coli",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3042-9",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - CRE Enterobacter"
} ],
"text": "Report no labID event - All specimens - CRE Enterobacter",
"type": "boolean",
"linkId": "no-lab-id-event-mrsa-cre-enterobacter",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3045-2",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - CRE Klebsiella"
} ],
"text": "Report no labID event - All specimens - CRE Klebsiella",
"type": "boolean",
"linkId": "no-lab-id-event-cre-klebsiella",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3048-6",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - Acinetobacter"
} ],
"text": "Report no labID event - All specimens - Acinetobacter",
"type": "boolean",
"linkId": "no-lab-id-event-mdr-acinetobacter",
"repeats": false,
"required": false
}, {
"code": [ {
"code": "3051-0",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Report no labID event - All specimens - Clostridium difficile"
} ],
"text": "Report no labID event - All specimens - Clostridium difficile",
"type": "boolean",
"linkId": "no-lab-id-event-c-difficile",
"repeats": false,
"required": false
} ],
"text": "Report no events",
"type": "group",
"linkId": "report-no-events-group",
"repeats": false,
"required": false
} ],
"type": null,
"experimental": "false",
"resourceType": "Questionnaire",
"title": "MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF",
"package_version": "0.1.0",
"status": "draft",
"language": "en-US",
"id": "c11d2abc-9ff0-4952-9ed9-b02eac3693fc",
"kind": null,
"url": "http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary",
"code": [ {
"code": "1657-6",
"system": "http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277",
"display": "Summary data reporting outpatient procedure component events at a facility"
} ],
"identifier": [ {
"value": "hai-ltcf-questionnaire-mdro-cdi-summary-v1"
} ],
"version": "1.0.0"
}