{
  "description": "This Questionnaire instance defines the questions and possible answers in the following CDC NHSN forms:     * [Denominators for LTCF (CDC 57.142](https://www.cdc.gov/nhsn/forms/57.142_DenominatorLTCF_BLANK.pdf)     * [MDRO and CDI Monthly Monitoring for LTCF (CDC 57.139)](https://www.cdc.gov/nhsn/forms/57.139_MDROMonthlyReporting_LTCF_BLANK.pdf)     * [Prevention Process Measures Form for LTCF (CDC 57.143)](https://www.cdc.gov/nhsn/forms/57.143_ProcessMeasureSummaryforLTCF_BLANK.pdf)",
  "_filename": "example/Questionnaire-hai-ltcf-questionnaire-mdro-cdi-summary.json",
  "package_name": "hl7.fhir.us.hai-ltcf",
  "subjectType": [ "Group" ],
  "date": "2023-04-19T15:00:27+00:00",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/hai-ltcf/StructureDefinition/hai-ltc-population-summary-questionnaire" ]
  },
  "publisher": "HL7 Public Health Work Group (http://www.hl7.org/Special/committees/pher/index.cfm)",
  "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://cts.nlm.nih.gov/fhir/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 is a set of summary data for a population in the defined NHSN protocol.",
      "type": "display",
      "linkId": "summary-data-group-display"
    }, {
      "item": [ {
        "text": "The Summary Data Group - Denominator is a set of summary data reported using the CDC NHSN form: [Denominators for LTCF (CDC 57.142](https://www.cdc.gov/nhsn/forms/57.142_DenominatorLTCF_BLANK.pdf).",
        "type": "display",
        "linkId": "summary-data-group-denom-display"
      }, {
        "code": [ {
          "code": "1345-8",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Total Resident Days"
        } ],
        "text": "Total Resident Days",
        "type": "quantity",
        "linkId": "total-resident-days",
        "repeats": false,
        "required": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
          "valueCoding": {
            "code": "d",
            "system": "http://unitsofmeasure.org",
            "display": "d"
          }
        } ]
      }, {
        "code": [ {
          "code": "1853-1",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of urinary catheter days"
        } ],
        "text": "Urinary Catheter Days",
        "type": "quantity",
        "linkId": "urinary-catheter-days",
        "repeats": false,
        "required": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
          "valueCoding": {
            "code": "d",
            "system": "http://unitsofmeasure.org",
            "display": "d"
          }
        } ]
      }, {
        "code": [ {
          "code": "1343-3",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "New antibiotic starts for UTI indication"
        } ],
        "text": "New Antibiotic Starts for UTI Indication",
        "type": "integer",
        "linkId": "new-antibiotic-starts-for-uti-indication",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1344-1",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of urine cultures ordered"
        } ],
        "text": "Number of Urine Cultures Ordered",
        "type": "integer",
        "linkId": "number-urine-cultures-ordered",
        "repeats": false,
        "required": true
      } ],
      "text": "Summary Data Group - Denominator",
      "type": "group",
      "linkId": "summary-data-group-denom",
      "repeats": false,
      "required": true
    }, {
      "item": [ {
        "text": "The Summary Data Group - MDRO/CDI is a set of summary data reported using the CDC NHSN form: [MDRO and CDI Monthly Monitoring for LTCF (CDC 57.139)](https://www.cdc.gov/nhsn/forms/57.139_MDROMonthlyReporting_LTCF_BLANK.pdf).",
        "type": "display",
        "linkId": "summary-data-group-mdro-cdi-display"
      }, {
        "code": [ {
          "code": "1369-8",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Resident days"
        } ],
        "text": "Resident Days",
        "type": "quantity",
        "linkId": "resident-days",
        "repeats": false,
        "required": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
          "valueCoding": {
            "code": "d",
            "system": "http://unitsofmeasure.org",
            "display": "d"
          }
        } ]
      }, {
        "code": [ {
          "code": "1370-6",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Resident admissions"
        } ],
        "text": "Resident Admissions",
        "type": "integer",
        "linkId": "resident-admissions",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1371-4",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of admissions on C. difficile treatment"
        } ],
        "text": "Number of admissions on C. difficile treatment",
        "type": "integer",
        "linkId": "number-admissions-on-c-diff-treatment",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1372-2",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of C. difficile treatment starts"
        } ],
        "text": "Number of C. difficile treatment starts",
        "type": "integer",
        "linkId": "number-c-diff-treatment-starts",
        "repeats": false,
        "required": true
      } ],
      "text": "Summary Data Group - MDRO/CDI",
      "type": "group",
      "linkId": "summary-data-group-mdro-cdi",
      "repeats": false,
      "required": true
    }, {
      "item": [ {
        "text": "The Summary Data Group - Prevention Process Measures is a set of summary data reported using the CDC NHSN form: [Prevention Process Measures Form for LTCF (CDC 57.143)](https://www.cdc.gov/nhsn/forms/57.143_ProcessMeasureSummaryforLTCF_BLANK.pdf).",
        "type": "display",
        "linkId": "summary-data-group-prevention-process-measures-display"
      }, {
        "code": [ {
          "code": "1865-5",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of observations in which hand hygiene was performed"
        } ],
        "text": "Hand Hygiene Performed",
        "type": "integer",
        "linkId": "hand-hygiene-performed",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1864-8",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of observations in which hand hygiene was indicated"
        } ],
        "text": "Hand Hygiene Indicated",
        "type": "integer",
        "linkId": "hand-hygiene-indicated",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1867-1",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of observations in which gown and gloves were used"
        } ],
        "text": "Gown and Gloves Used",
        "type": "integer",
        "linkId": "gown-and-gloves-used",
        "repeats": false,
        "required": true
      }, {
        "code": [ {
          "code": "1866-3",
          "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
          "display": "Number of observations in which the use of gown and gloves was indicated"
        } ],
        "text": "Gown and Gloves Indicated",
        "type": "integer",
        "linkId": "gown-and-gloves-indicated",
        "repeats": false,
        "required": true
      } ],
      "text": "Summary Data Group - Prevention Process Measures",
      "type": "group",
      "linkId": "summary-data-group-prevention-process-measures",
      "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": "1342-5",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: UTI Event"
      } ],
      "text": "Report No Events: UTI Event",
      "type": "boolean",
      "linkId": "no-lab-id-uti-event",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3030-4",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): MRSA"
      } ],
      "text": "Report No Events: LabID Event (All specimens): MRSA",
      "type": "boolean",
      "linkId": "no-lab-id-event-mrsa",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "1307-8",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): MSSA"
      } ],
      "text": "Report No Events: LabID Event (All specimens): MSSA",
      "type": "boolean",
      "linkId": "no-lab-id-event-mssa",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3033-8",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): VRE"
      } ],
      "text": "Report No Events: LabID Event (All specimens): VRE",
      "type": "boolean",
      "linkId": "no-lab-id-event-vre",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3036-1",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): CephR Klebsiella"
      } ],
      "text": "Report No Events: LabID Event (All specimens): CephR Klebsiella",
      "type": "boolean",
      "linkId": "no-lab-id-event-cephr-klebsiella",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3039-5",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): CRE-E. coli"
      } ],
      "text": "Report No Events: 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": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): CRE-Enterobacter"
      } ],
      "text": "Report No Events: 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": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): CRE-Klebsiella"
      } ],
      "text": "Report No Events: LabID Event (All specimens): CRE-Klebsiella",
      "type": "boolean",
      "linkId": "no-lab-id-event-cre-klebsiella",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3048-6",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): MDR-Acinetobacter"
      } ],
      "text": "Report No Events: LabID Event (All specimens): MDR-Acinetobacter",
      "type": "boolean",
      "linkId": "no-lab-id-event-mdr-acinetobacter",
      "repeats": false,
      "required": false
    }, {
      "code": [ {
        "code": "3051-0",
        "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
        "display": "Report No Events: LabID Event (All specimens): C. difficile"
      } ],
      "text": "Report No Events: LabID Event (All specimens): C. 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": "1.1.0",
  "status": "draft",
  "language": "en-US",
  "id": "d3756f50-3d87-44ae-b0d8-c088f53beb67",
  "kind": null,
  "url": "http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary",
  "code": [ {
    "code": "51897-7",
    "system": "http://loinc.org",
    "display": "Healthcare Associated Infection report Document"
  }, {
    "code": "1891-1",
    "system": "https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/cdcnhsn.html",
    "display": "Summary data reporting MDRO and CDI LabID Event for LTCF"
  } ],
  "identifier": [ {
    "value": "hai-ltcf-questionnaire-mdro-cdi-summary-v1.1"
  } ],
  "version": "1.1.0",
  "contact": [ {
    "name": "HL7 International - Public Health",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/pher",
      "system": "url"
    } ]
  } ]
}