CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
1.0.0 - Release 1

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Downloaded Version 1.0.0 See the Directory of published versions

## Example Bundle: Full ACH Monthly Measure Submission Bundle

Profile: NHSN MeasureReport Bundle

Bundle submission-full-example1 of type collection

Entry 1 - fullUrl = http://nhsnlink.org/fhir/Organization/organization-example-submitting-organization

Resource Organization:

> Profile: NHSN Submitting Organization

> identifier: `https://www.cdc.gov/nhsn/OrgID`/ExampleNHSNSubmitterOrgID

> active: true

> type: Healthcare Provider

> name: Example NHSN Submitter

> ### Contacts

> - | Telecom | Address
> * | ph: 5555555551 |

Entry 2 - fullUrl = http://nhsnlink.org/fhir/Device/device-example-submitting-device

Resource Device:

> Profile: NHSN Submitting Device

> > version

> > component: api

> > value: 0.9.0

> > version

> > component: api

> > value: 20230713.1

> > version

> > component: api

> > value: 3f9662a8

> > version

> > component: cqf-ruler

> > value: 0.13.0

Entry 3 - fullUrl = http://nhsnlink.org/fhir/List/list-example-ach-monthly-patients-of-interest

Resource List:

> Profile: Patients-Of-Interest List

> Date: 2021-07-28 00:00:00+0000 | Mode: Change List | Status: Current

> Items
> Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))
> Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))
> Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

Entry 4 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-ach-monthly-subjectlist1

Resource MeasureReport:

> Profile: Subject-List MeasureReport Profile

> status: Complete

> type: Subject List

> measure: NHSN dQM Acute Care Hospital Monthly Initial Populationversion: null1.0.0)

> period: 2022-08-01 00:00:00+0000 --> 2022-08-31 23:59:59+0000

> > group

> > ### Populations

> > - | Code | Count | SubjectResults
> > * | Initial Population | 1 | List for 'Unspecified List Type' for 'Unspecified Subject'

> > Profile: NHSN Individual MeasureReport List

> > Mode: Snapshot List | Status: Current

> > Items
> > MeasureReport: extension = Cohort,->Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, )),->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual, ); status = in-progress; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = Hospital admission (procedure); period = 2024-02-01 16:02:00-0500 --> 2024-02-04 19:00:00-0500; reasonCode = Fever, unspecified,->Coverage: identifier = Member Number: 084536836; status = active; type = subsidized health program; subscriberId = 98435938934; relationship = Child; period = 2020-08-01 --> (ongoing),->Condition Bacteremia (finding),->Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#1000510341 (use: usual, ); type = Central venous catheter, device (physical object),->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->vancomycin Injectable Solution 50MG; effective[x] = 2024-02-02 14:34:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->vancomycin Injectable Solution 50MG; authoredOn = 2024-02-02 13:43:00-0500,->Observation Bacteria identified in Blood by Culture,->Observation Serratia marcescens DNA [Presence] in Specimen by NAA with probe detection,->Observation Gestational age--at birth,->Observation Body weight,->Procedure Placement procedure (procedure),->Procedure Drainage of Spinal Canal, Percutaneous Approach, Diagnostic,->ServiceRequest Bacteria identified in Blood by Culture,->ServiceRequest Differential panel - Cerebral spinal fluid,->Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082901,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:41; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500,->Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Cerebrospinal fluid specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500; identifier = http://example.org/fhir/measurereport/id#123456789-pass1; status = complete; type = individual; measure = http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation|1.0.0-cibuild; date = 2024-02-05 21:04:29+0000; period = 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000; improvementNotation = Increased score indicates improvement
> > MeasureReport: extension = Cohort,->Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, )),->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252a (use: usual, ); status = triaged; class = emergency (ActCode[9.0.0]#EMER); type = Emergency department patient visit; period = 2024-01-31 02:35:00-0500 --> 2024-01-31 22:02:00-0500; reasonCode = Pain in right lower leg,->Encounter: extension = eloBHVi6UskNwFJ55XgUq294CfCWyE3tytd.P4NomlhQprDjGoqWBeK2-ed8C2oMs3; identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252b (use: usual, ); status = finished; class = inpatient encounter (ActCode[9.0.0]#IMP); type = Hospital admission (procedure); period = 2024-01-31 22:02:00-0500 --> 2024-02-02 16:22:00-0500,->Coverage: identifier = Member Number: 93565936; status = active; type = health maintenance organization policy; subscriberId = 89345743; relationship = Self,->Condition Diabetes mellitus type 2 (disorder),->Condition Thrombophlebitis of deep femoral vein (disorder),->Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051034 (use: usual, ); type = Graduated compression elastic hosiery (physical object),->Diagnostic Report for 'Doppler ultrasonography of vascular structure of right lower limb (procedure)' for '->Pass2 ACH',->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual, ); status = completed; category = Outpatient; medication[x] = ->Dex4 4 gm chewable tablet X1; effective[x] = 2024-01-31 04:54:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-02 13:26:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 12:00:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888943 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 19:00:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888944 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 07:00:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888945 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 15:00:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Outpatient; reported[x] = true; medication[x] = ->Dex4 4 gm chewable tablet X1; authoredOn = 2024-01-31 04:46:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Metformin hydrochloride 1000 MG; authoredOn = 2024-01-31 04:22:00-0500,->Observation aPTT in Blood by Coagulation assay,->Observation Glucose [Mass/volume] in Capillary blood by Glucometer,->Observation Glucose [Mass/volume] in Capillary blood by Glucometer,->Observation Hemoglobin A1c/Hemoglobin.total in Blood,->Observation Bacteria identified in Blood by Culture,->Observation Body weight,->Procedure Percutaneous insertion of inferior vena cava filter (procedure),->ServiceRequest aPTT in Blood by Coagulation assay,->ServiceRequest Glucose [Mass/volume] in Capillary blood by Glucometer,->ServiceRequest Hemoglobin A1c [Mass/volume] in Blood,->ServiceRequest Hemoglobin [Mass/volume] in Venous blood,->Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500,->Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 11:26:00-0500; identifier = http://example.org/fhir/measurereport/id#123456789-pass2; status = complete; type = individual; measure = http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation|1.0.0-cibuild; date = 2024-02-05 21:04:29+0000; period = 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000; improvementNotation = Increased score indicates improvement
> > MeasureReport: extension = Cohort,->Condition Acute sinusitis (disorder),->Condition Enterocolitis due to Clostridium difficile,->Coverage: identifier = Member Number: 0945345; status = active; type = preferred provider organization policy; subscriberId = 7843574536; relationship = Self,->Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051035 (use: usual, ); type = Intermittent venous compression system pump (physical object),->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = finished; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = In-person encounter; period = 2024-02-02 16:43:00-0500 --> 2024-02-03 19:58:00-0500,->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = in-progress; class = short stay (ActCode[9.0.0]#SS); type = Hospital admission, elective (procedure); period = 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500; reasonCode = Diarrhea, unspecified,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = not-done; category = Inpatient; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; effective[x] = 2024-02-02 21:04:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888321 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-01 21:02:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888322 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-02 21:09:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888323 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-03 09:09:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Ciprofloxacin 500 MG; authoredOn = 2024-02-01 19:15:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500,->Observation Clostridioides difficile (organism),->Observation Body height,->Observation Body weight,->Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, )),->Procedure Transfusion of red blood cells (procedure),->ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay,->Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500; identifier = http://example.org/fhir/measurereport/id#123456789-pass3; status = complete; type = individual; measure = http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation|1.0.0-cibuild; date = 2024-02-05 21:04:29+0000; period = 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000; improvementNotation = Increased score indicates improvement

Entry 5 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-individual-ach-monthly-pass1

Resource MeasureReport:

> Profile: DEQM Individual MeasureReport Profile

> DEQM Measure Scoring Extension: Cohort

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual, ); status = in-progress; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = Hospital admission (procedure); period = 2024-02-01 16:02:00-0500 --> 2024-02-04 19:00:00-0500; reasonCode = Fever, unspecified

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Coverage: identifier = Member Number: 084536836; status = active; type = subsidized health program; subscriberId = 98435938934; relationship = Child; period = 2020-08-01 --> (ongoing)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Condition Bacteremia (finding)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#1000510341 (use: usual, ); type = Central venous catheter, device (physical object)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->vancomycin Injectable Solution 50MG; effective[x] = 2024-02-02 14:34:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->vancomycin Injectable Solution 50MG; authoredOn = 2024-02-02 13:43:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Bacteria identified in Blood by Culture

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Serratia marcescens DNA [Presence] in Specimen by NAA with probe detection

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Gestational age--at birth

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Body weight

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Procedure Placement procedure (procedure)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Procedure Drainage of Spinal Canal, Percutaneous Approach, Diagnostic

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Bacteria identified in Blood by Culture

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Differential panel - Cerebral spinal fluid

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082901,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:41; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Cerebrospinal fluid specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

> identifier: `http://example.org/fhir/measurereport/id`/123456789-pass1

> status: Complete

> type: Individual

> measure: NHSN dQM Acute Care Hospital Monthly Initial Populationversion: null1.0.0)

> subject: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> date: 2024-02-05 21:04:29+0000

> reporter: Organization Example NHSN Submitter

> period: 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000

> improvementNotation: Increased score indicates improvement

> > group

> > ### Populations

> > - | Code | Count
> > * | Initial Population | 1

> evaluatedResource:

> - Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))
> - Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual, ); status = in-progress; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = Hospital admission (procedure); period = 2024-02-01 16:02:00-0500 --> 2024-02-04 19:00:00-0500; reasonCode = Fever, unspecified
> - Coverage: identifier = Member Number: 084536836; status = active; type = subsidized health program; subscriberId = 98435938934; relationship = Child; period = 2020-08-01 --> (ongoing)
> - Condition Bacteremia (finding)
> - Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#1000510341 (use: usual, ); type = Central venous catheter, device (physical object)
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->vancomycin Injectable Solution 50MG; effective[x] = 2024-02-02 14:34:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->vancomycin Injectable Solution 50MG; authoredOn = 2024-02-02 13:43:00-0500
> - Observation Bacteria identified in Blood by Culture
> - Observation Serratia marcescens DNA [Presence] in Specimen by NAA with probe detection
> - Observation Gestational age--at birth
> - Observation Body weight
> - Procedure Placement procedure (procedure)
> - Procedure Drainage of Spinal Canal, Percutaneous Approach, Diagnostic
> - ServiceRequest Bacteria identified in Blood by Culture
> - ServiceRequest Differential panel - Cerebral spinal fluid
> - Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082901,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:41; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500
> - Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Cerebrospinal fluid specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

Entry 6 - fullUrl = http://nhsnlink.org/fhir/Patient/patient-example-ach-monthly-pass1

Resource Patient:

> Profile: Cross-Measure Patient Profile

> Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> Active: | true | Deceased: | false
> Contact Detail | ph: 999-999-9999(Home) 456 Alphabet Street Lansing MI 48864 US (home)
> Language: | English (United States)
> Next-of-Kin: | Mom Parent 456 Alphabet Street Lansing MI 48864
> US Core Ethnicity Extension: | ombCategory: Race & Ethnicity - CDC 2135-2: Hispanic or Latino text: Hispanic or Latino
> US Core Birth Sex Extension | M
> US Core Race Extension: | ombCategory: Race & Ethnicity - CDC 2054-5: Black or African American text: Black or African American

Entry 7 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass1

Resource Encounter:

> Profile: ACH Monthly Event Encounter

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005104251 (use: usual, )

> status: In Progress

> class: inpatient acute

> type: Hospital Admission

> subject: Pass1 ACH

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Thrombophlebitis)

> ### Locations

> - | Location | Period
> * | ACH Monthly Neonatal critical care | 2024-02-01 16:02:00-0500 --> 2024-02-02 16:02:00-0500

Entry 8 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ach-monthly-pass1

Resource Coverage:

> Profile: ACH Monthly Event Coverage

> identifier: Member Number/084536836

> status: Active

> type: subsidized health program

> policyHolder: Mom Parent

> subscriberId: 98435938934

> beneficiary: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> relationship: Child

> period: 2020-08-01 --> (ongoing)

Entry 9 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass1

Resource Condition:

> Profile: ACH Monthly Event Condition

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Encounter Diagnosis

> code: Bacteremia

> subject: Pass1 ACH

Entry 10 - fullUrl = http://nhsnlink.org/fhir/Device/device-example-ach-monthly-pass1-central-line

Resource Device:

> Profile: ACH Monthly Event Device

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/1000510341 (use: usual, )

> type: Central venous catheter, device

Entry 11 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass1-vancomycin

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888111 (use: usual, )

> status: completed

> category: Inpatient

> subject: Pass1 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->vancomycin Injectable Solution 50MG; authoredOn = 2024-02-02 13:43:00-0500

> ### Dosages

> - | Text | Route | Dose
> * | 15mg/kg | IV | 15 mg/kg (Details: UCUM codemg/kg = 'mg/kg')

Entry 12 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass1-vancomycin

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888811 (use: usual, )

> status: Completed

> intent: Order

> category: Inpatient

> subject: Pass1 ACH

> encounter: Hospital Admission

> authoredOn: 2024-02-02 13:43:00-0500

> requester: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> > dosageInstruction

> > text: 15mg/kg every 12 hours

> > timing: Once per 12 hours

> > route: IV

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 15 mg/kg (Details: UCUM codemg/kg = 'mg/kg')

Entry 13 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass1-blood

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Bacteria identified in Blood by Culture

> status: Final

> category: Laboratory

> code: Bacteria identified in Blood by Culture

> subject: Pass1 ACH

> encounter: Hospital Admission

> effective: 2024-02-02 18:12:00-0500

> issued: 2024-02-03 11:42:00-0500

> value: Staphylococcus capitis

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082901,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:41; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

Entry 14 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass1-csf

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Differential panel - Cerebral spinal fluid

> status: Final

> category: Laboratory

> code: Serratia marcescens DNA

> subject: Pass1 ACH

> encounter: Hospital Admission

> effective: 2024-02-02 18:13:00-0500

> issued: 2024-02-03 11:47:00-0500

> value: Detected (qualifier value)

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Cerebrospinal fluid specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

Entry 15 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass1-gestational-age

Resource Observation:

> Profile: ACH Monthly Event Observation

> status: Final

> category: Exam

> code: Gestational age at birth

> subject: Pass1 ACH

> encounter: Hospital Admission

> effective: 2024-02-01 16:02:00-0500

> issued: 2024-02-01 16:02:00-0500

> value: 164 day (Details: UCUM coded = 'd')

Entry 16 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass1-vitals-weight

Resource Observation:

> Profile: ACH Monthly Event Observation - Vital Signs

> status: Final

> category: Vital Signs

> code: Weight

> subject: Pass1 ACH

> encounter: Hospital Admission

> effective: 2024-02-01 16:02:00-0500

> issued: 2024-02-01 16:02:00-0500

> value: 0.58 kg (Details: UCUM codekg = 'kg')

Entry 17 - fullUrl = http://nhsnlink.org/fhir/Procedure/procedure-example-ach-monthly-pass1-central-line

Resource Procedure:

> Profile: ACH Monthly Event Procedure

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/1000510352 (use: usual, )

> status: Completed

> code: Placement procedure (procedure)

> subject: Pass1 ACH

> encounter: Hospital Admission

Entry 18 - fullUrl = http://nhsnlink.org/fhir/Procedure/procedure-example-ach-monthly-pass1-lumbar

Resource Procedure:

> Profile: ACH Monthly Event Procedure

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/1000510352 (use: usual, )

> status: Completed

> code: Drainage of Spinal Canal, Percutaneous Approach, Diagnostic

> subject: Pass1 ACH

> encounter: Hospital Admission

> bodySite: Structure of superior articular process of lumbar vertebra

Entry 19 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass1-blood

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631821 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> code: No display for ServiceRequest.code (concept: Bacteria identified in Blood by Culture)

> quantity: 1

> subject: Pass1 ACH

> encounter: Hospital Admission

> occurrence: Code , Events: 2024-02-02 17:22:00-0500 , Count 1 times, Once

> authoredOn: 2024-02-02 17:22:00-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082901,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:41; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

Entry 20 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass1-csf

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631822 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> code: No display for ServiceRequest.code (concept: Differential panel - Cerebral spinal fluid)

> quantity: 1

> subject: Pass1 ACH

> encounter: Hospital Admission

> occurrence: Code , Events: 2024-02-02 17:22:30-0500 , Count 1 times, Once

> authoredOn: 2024-02-02 17:22:30-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Cerebrospinal fluid specimen (specimen); receivedTime = 2024-02-02 18:20:00-0500

Entry 21 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass1-blood

Resource Specimen:

> Profile: ACH Monthly Event Specimen

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798.32`/C104082901, `urn:oid:2.16.840.1.113883.19.5.1.798.800`/C10408290:41

> type: Venous blood specimen (specimen)

> subject: Pass1 ACH

> receivedTime: 2024-02-02 18:20:00-0500

> ### Collections

> - | Collected[x] | BodySite
> * | 2024-02-02 18:12:00-0500 | No display for Specimen.collection.bodySite (concept: Heel structure (body structure))

Entry 22 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass1-csf

Resource Specimen:

> Profile: ACH Monthly Event Specimen

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798.32`/C104082902, `urn:oid:2.16.840.1.113883.19.5.1.798.800`/C10408290:42

> type: Cerebrospinal fluid specimen (specimen)

> subject: Pass1 ACH

> receivedTime: 2024-02-02 18:20:00-0500

> ### Collections

> - | Collected[x] | BodySite
> * | 2024-02-02 18:13:00-0500 | No display for Specimen.collection.bodySite (concept: Structure of superior articular process of lumbar vertebra (body structure))

Entry 23 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-individual-ach-monthly-pass2

Resource MeasureReport:

> Profile: DEQM Individual MeasureReport Profile

> DEQM Measure Scoring Extension: Cohort

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252a (use: usual, ); status = triaged; class = emergency (ActCode[9.0.0]#EMER); type = Emergency department patient visit; period = 2024-01-31 02:35:00-0500 --> 2024-01-31 22:02:00-0500; reasonCode = Pain in right lower leg

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Encounter: extension = eloBHVi6UskNwFJ55XgUq294CfCWyE3tytd.P4NomlhQprDjGoqWBeK2-ed8C2oMs3; identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252b (use: usual, ); status = finished; class = inpatient encounter (ActCode[9.0.0]#IMP); type = Hospital admission (procedure); period = 2024-01-31 22:02:00-0500 --> 2024-02-02 16:22:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Coverage: identifier = Member Number: 93565936; status = active; type = health maintenance organization policy; subscriberId = 89345743; relationship = Self

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Condition Diabetes mellitus type 2 (disorder)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Condition Thrombophlebitis of deep femoral vein (disorder)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051034 (use: usual, ); type = Graduated compression elastic hosiery (physical object)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Diagnostic Report for 'Doppler ultrasonography of vascular structure of right lower limb (procedure)' for '->Pass2 ACH'

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual, ); status = completed; category = Outpatient; medication[x] = ->Dex4 4 gm chewable tablet X1; effective[x] = 2024-01-31 04:54:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-02 13:26:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 12:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888943 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 19:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888944 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 07:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888945 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 15:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Outpatient; reported[x] = true; medication[x] = ->Dex4 4 gm chewable tablet X1; authoredOn = 2024-01-31 04:46:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Metformin hydrochloride 1000 MG; authoredOn = 2024-01-31 04:22:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation aPTT in Blood by Coagulation assay

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Glucose [Mass/volume] in Capillary blood by Glucometer

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Glucose [Mass/volume] in Capillary blood by Glucometer

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Hemoglobin A1c/Hemoglobin.total in Blood

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Bacteria identified in Blood by Culture

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Body weight

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Procedure Percutaneous insertion of inferior vena cava filter (procedure)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest aPTT in Blood by Coagulation assay

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Glucose [Mass/volume] in Capillary blood by Glucometer

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Hemoglobin A1c [Mass/volume] in Blood

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Hemoglobin [Mass/volume] in Venous blood

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 11:26:00-0500

> identifier: `http://example.org/fhir/measurereport/id`/123456789-pass2

> status: Complete

> type: Individual

> measure: NHSN dQM Acute Care Hospital Monthly Initial Populationversion: null1.0.0)

> subject: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> date: 2024-02-05 21:04:29+0000

> reporter: Organization Example NHSN Submitter

> period: 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000

> improvementNotation: Increased score indicates improvement

> > group

> > ### Populations

> > - | Code | Count
> > * | Initial Population | 1

> evaluatedResource:

> - Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))
> - Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252a (use: usual, ); status = triaged; class = emergency (ActCode[9.0.0]#EMER); type = Emergency department patient visit; period = 2024-01-31 02:35:00-0500 --> 2024-01-31 22:02:00-0500; reasonCode = Pain in right lower leg
> - Encounter: extension = eloBHVi6UskNwFJ55XgUq294CfCWyE3tytd.P4NomlhQprDjGoqWBeK2-ed8C2oMs3; identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104252b (use: usual, ); status = finished; class = inpatient encounter (ActCode[9.0.0]#IMP); type = Hospital admission (procedure); period = 2024-01-31 22:02:00-0500 --> 2024-02-02 16:22:00-0500
> - Coverage: identifier = Member Number: 93565936; status = active; type = health maintenance organization policy; subscriberId = 89345743; relationship = Self
> - Condition Diabetes mellitus type 2 (disorder)
> - Condition Thrombophlebitis of deep femoral vein (disorder)
> - Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051034 (use: usual, ); type = Graduated compression elastic hosiery (physical object)
> - Diagnostic Report for 'Doppler ultrasonography of vascular structure of right lower limb (procedure)' for '->Pass2 ACH'
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual, ); status = completed; category = Outpatient; medication[x] = ->Dex4 4 gm chewable tablet X1; effective[x] = 2024-01-31 04:54:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; effective[x] = 2024-02-02 13:26:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 12:00:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888943 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-01 19:00:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888944 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 07:00:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888945 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Insulin Lispro; effective[x] = 2024-02-02 15:00:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Outpatient; reported[x] = true; medication[x] = ->Dex4 4 gm chewable tablet X1; authoredOn = 2024-01-31 04:46:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Metformin hydrochloride 1000 MG; authoredOn = 2024-01-31 04:22:00-0500
> - Observation aPTT in Blood by Coagulation assay
> - Observation Glucose [Mass/volume] in Capillary blood by Glucometer
> - Observation Glucose [Mass/volume] in Capillary blood by Glucometer
> - Observation Hemoglobin A1c/Hemoglobin.total in Blood
> - Observation Bacteria identified in Blood by Culture
> - Observation Body weight
> - Procedure Percutaneous insertion of inferior vena cava filter (procedure)
> - ServiceRequest aPTT in Blood by Coagulation assay
> - ServiceRequest Glucose [Mass/volume] in Capillary blood by Glucometer
> - ServiceRequest Hemoglobin A1c [Mass/volume] in Blood
> - ServiceRequest Hemoglobin [Mass/volume] in Venous blood
> - Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500
> - Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 11:26:00-0500

Entry 24 - fullUrl = http://nhsnlink.org/fhir/Patient/patient-example-ach-monthly-pass2

Resource Patient:

> Profile: Cross-Measure Patient Profile

> Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> Active: | true | Deceased: | 2024-02-02 16:22:00-0500
> Contact Detail | ph: 999-999-9999(Home) 123 Sesame Street Lansing Lansing MI 48864 US
> US Core Ethnicity Extension: | ombCategory: Race & Ethnicity - CDC 2186-5: Not Hispanic or Latino text: Non Hispanic or Latino
> US Core Birth Sex Extension | F
> US Core Race Extension: | ombCategory: Race & Ethnicity - CDC 2106-3: White text: White

Entry 25 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass2-emergency

Resource Encounter:

> Profile: ACH Monthly Event Encounter

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005104252a (use: usual, )

> status: In Progress

> class: emergency

> type: Emergency department patient visit

> subject: Pass2 ACH

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Thrombophlebitis)

> ### Locations

> - | Location | Period
> * | ACH Monthly Emergency Department | 2024-01-31 02:35:00-0500 --> 2024-02-01 01:02:00-0500

Entry 26 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass2-inpatient

Resource Encounter:

> Profile: ACH Monthly Event Encounter

> Original Resource ID: eloBHVi6UskNwFJ55XgUq294CfCWyE3tytd.P4NomlhQprDjGoqWBeK2-ed8C2oMs3

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005104252b (use: usual, )

> status: completed

> class: inpatient encounter

> type: Hospital Admission

> subject: Pass2 ACH

> ### Locations

> - | Location | Period
> * | ACH Monthly Inpatient Hospital Ward | 2024-02-01 01:02:00-0500 --> 2024-02-02 16:22:00-0500

Entry 27 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ach-monthly-pass2

Resource Coverage:

> Profile: ACH Monthly Event Coverage

> identifier: Member Number/93565936

> status: Active

> type: health maintenance organization policy

> subscriberId: 89345743

> beneficiary: Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> relationship: Self

Entry 28 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass2-problem

Resource Condition:

> Profile: ACH Monthly Event Condition

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem List Item

> code: Diabetes mellitus without complication

> subject: Pass2 ACH

Entry 29 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass2

Resource Condition:

> Profile: ACH Monthly Event Condition

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Encounter Diagnosis

> code: Thrombophlebitis

> subject: Pass2 ACH

Entry 30 - fullUrl = http://nhsnlink.org/fhir/Device/device-example-ach-monthly-pass2-compress-hose

Resource Device:

> Profile: ACH Monthly Event Device

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/100051034 (use: usual, )

> type: Graduated compression elastic hosiery

Entry 31 - fullUrl = http://nhsnlink.org/fhir/DiagnosticReport/diagnosticreport-example-ach-monthly-pass2-radiology

Resource DiagnosticReport:

> Profile: ACH Monthly Event Diagnostic Report - Report and Note

> ## ultrasonography of right lower limb (Radiology)

> Subject | Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))
> When For | 2024-02-01 23:14:00-0500
> Reported | 2024-02-02 08:52:00-0500

> Report Details

> Coded Conclusions:

> - Deep venous thrombosis (disorder)

Entry 32 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-dex4

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888893 (use: usual, )

> status: completed

> category: Outpatient

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Outpatient; reported[x] = true; medication[x] = ->Dex4 4 gm chewable tablet X1; authoredOn = 2024-01-31 04:46:00-0500

> ### Dosages

> - | Text | Route | Dose
> * | 4 gm chewable tablet X1 | Oral | 4 g (Details: UCUM codeg = 'g')

Entry 33 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-heparin-1

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888895 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | 0.5 mL | Structure of blood vessel of left upper arm (body structure) | IV | 5000 uL (Details: UCUM codeuL = 'uL')

Entry 34 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-heparin-2

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888895 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.5 ML heparin sodium, porcine 10000 UNT/ML Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | 0.5 mL | Structure of blood vessel of left upper arm (body structure) | IV | 5000 uL (Details: UCUM codeuL = 'uL')

Entry 35 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-insulin-lispro-1

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888942 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | Give 5 units before breakfast | Structure of blood vessel of left upper arm (body structure) | IV | 5

Entry 36 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-insulin-lispro-2

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888943 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | Give 5 units before dinner | Structure of blood vessel of left upper arm (body structure) | IV | 4

Entry 37 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-insulin-lispro-3

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888944 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | Give 5 units before breakfast | Structure of blood vessel of left upper arm (body structure) | IV | 5

Entry 38 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass2-insulin-lispro-4

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888945 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual, ); status = completed; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Insulin Lispro; authoredOn = 2024-02-01 12:00:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | Give 5 units before dinner | Structure of blood vessel of left upper arm (body structure) | IV | 4

Entry 39 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass2-dex4-tablet

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888892 (use: usual, )

> status: Active

> intent: Plan

> category: Outpatient

> subject: Pass2 ACH

> encounter: Emergency Encounter

> authoredOn: 2024-01-31 04:46:00-0500

> requester: Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> > dosageInstruction

> > text: 4 gm chewable tablet X1

> > timing: Once per 1 day

> > route: Oral

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 4 g (Details: UCUM codeg = 'g')

Entry 40 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass2-heparin

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888895 (use: usual, )

> status: Completed

> intent: Order

> category: Inpatient Medication

> subject: Pass2 ACH

> encounter: Hospital Admission

> authoredOn: 2024-02-01 12:00:00-0500

> requester: Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> > dosageInstruction

> > text: 0.5 mL

> > timing: 2 per 1 day

> > site: Structure of blood vessel of left upper arm (body structure)

> > route: IV

> > ### DoseAndRates

> > - | Dose[x]
> > * | 5000 uL (Details: UCUM codeuL = 'uL')

Entry 41 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass2-insulin-lispro

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888894 (use: usual, )

> status: Completed

> intent: Order

> category: Inpatient Medication

> subject: Pass2 ACH

> encounter: Hospital Admission

> authoredOn: 2024-02-01 12:00:00-0500

> requester: Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> > dosageInstruction

> > text: Give 5 units before breakfast

> > timing: Code , Once per 1 day

> > site: Structure of blood vessel of left upper arm (body structure)

> > route: IV

> > ### DoseAndRates

> > - | Dose[x]
> > * | 5

> > dosageInstruction

> > text: Give 4 units before dinner

> > timing: Code , Once per 1 day

> > site: Structure of blood vessel of left upper arm (body structure)

> > route: IV

> > ### DoseAndRates

> > - | Dose[x]
> > * | 4

Entry 42 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass2-metformin

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888892 (use: usual, )

> status: Active

> intent: Plan

> category: Home Medication

> subject: Pass2 ACH

> encounter: Emergency Encounter

> authoredOn: 2024-01-31 04:22:00-0500

> requester: Pass2 ACH(official) Female, DoB: 1965-12-22 ( MRN: 1601191902010308 (use: usual, ))

> recorder: Patient Identified

> > dosageInstruction

> > text: 1000 mg tablet by mouth twice daily

> > timing: 2 per 1 day

> > route: Oral

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 1000 mg (Details: UCUM codemg = 'mg')

Entry 43 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-aptt

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest aPTT in Blood by Coagulation assay

> status: Final

> category: Laboratory

> code: aPTT

> subject: Pass2 ACH

> encounter: Hospital Admission

> effective: 2024-02-02 11:24:00-0500

> issued: 2024-02-02 11:29:00-0500

> value: 8 s (Details: UCUM codes = 's')

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500

Entry 44 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-poc-1

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Glucose [Mass/volume] in Capillary blood by Glucometer

> status: Final

> category: Laboratory

> code: Glucose

> subject: Pass2 ACH

> encounter: Hospital Admission

> effective: 2024-01-31 23:01:00-0500

> issued: 2024-01-31 23:02:00-0500

> value: 53 d/gL (Details: UCUM codeg/dL = 'g/dL')

Entry 45 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-poc-2

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Glucose [Mass/volume] in Capillary blood by Glucometer

> status: Final

> category: Laboratory

> code: Glucose

> subject: Pass2 ACH

> encounter: Hospital Admission

> effective: 2024-02-02 10:14:00-0500

> issued: 2024-02-02 10:15:00-0500

> value: 105 d/gL (Details: UCUM codeg/dL = 'g/dL')

Entry 46 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-hemo-a1c

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Hemoglobin A1c [Mass/volume] in Blood

> status: Final

> category: Laboratory

> code: Hemoglobin A1c

> subject: Pass2 ACH

> encounter: Hospital Admission

> effective: 2024-01-31 23:01:00-0500

> issued: 2024-01-31 23:52:00-0500

> value: 7.5 % (Details: UCUM code% = '%')

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500

Entry 47 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-hemo

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Hemoglobin [Mass/volume] in Venous blood

> status: Final

> category: Laboratory

> code: Bacteria identified in Blood by Culture

> subject: Pass2 ACH

> encounter: Hospital Admission

> effective: 2024-02-02 11:24:00-0500

> issued: 2024-02-02 11:29:00-0500

> value: 8 d/gL (Details: UCUM codeg/dL = 'g/dL')

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 11:26:00-0500

Entry 48 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass2-vitals-weight

Resource Observation:

> Profile: ACH Monthly Event Observation - Vital Signs

> status: Final

> category: Vital Signs

> code: Weight

> subject: Pass2 ACH

> encounter: Emergency Encounter

> effective: 2024-01-31 01:42:00-0500

> issued: 2024-01-31 01:42:00-0500

> value: 113.4 kg (Details: UCUM codekg = 'kg')

Entry 49 - fullUrl = http://nhsnlink.org/fhir/Procedure/procedure-example-ach-monthly-pass2-ivcf

Resource Procedure:

> Profile: ACH Monthly Event Procedure

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005103526 (use: usual, )

> status: Completed

> code: Percutaneous insertion of inferior vena cava filter (procedure)

> subject: Pass2 ACH

> encounter: Hospital Admission

Entry 50 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass2-aptt

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631824 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> priority: STAT

> code: No display for ServiceRequest.code (concept: aPTT in Blood by Coagulation assay)

> quantity: 1

> subject: Pass2 ACH

> encounter: Hospital Admission

> occurrence: Code , Events: 2024-01-31 22:21:00-0500 , Count 1 times, Once

> authoredOn: 2024-01-31 22:21:00-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500

Entry 51 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass2-glucose

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631824 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> code: No display for ServiceRequest.code (concept: Glucose [Mass/volume] in Capillary blood by Glucometer)

> quantity: 2

> subject: Pass2 ACH

> encounter: Hospital Admission

> occurrence: Code , Count 2 times, Once per 1 day

> authoredOn: 2024-01-31 22:21:00-0500

Entry 52 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass2-hemo-a1c

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631823 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> code: No display for ServiceRequest.code (concept: Hemoglobin A1c [Mass/volume] in Blood)

> quantity: 1

> subject: Pass2 ACH

> encounter: Hospital Admission

> occurrence: Code , Events: 2024-01-31 22:21:00-0500 , Count 1 times, Once

> authoredOn: 2024-01-31 22:21:00-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-01-31 22:50:00-0500

Entry 53 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass2-hemo

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631824 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> priority: STAT

> code: No display for ServiceRequest.code (concept: Hemoglobin [Mass/volume] in Venous blood)

> quantity: 1

> subject: Pass2 ACH

> encounter: Hospital Admission

> occurrence: Code , Events: 2024-02-02 11:22:00-0500 , Count 1 times, Once

> authoredOn: 2024-02-02 11:22:00-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082902,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:42; type = Venous blood specimen (specimen); receivedTime = 2024-02-02 11:26:00-0500

Entry 54 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass2-blood-1

Resource Specimen:

> Profile: ACH Monthly Event Specimen

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798.32`/C104082902, `urn:oid:2.16.840.1.113883.19.5.1.798.800`/C10408290:42

> type: Venous blood specimen (specimen)

> subject: Pass1 ACH

> receivedTime: 2024-01-31 22:50:00-0500

> ### Collections

> - | Collected[x] | BodySite
> * | 2024-01-31 22:42:00-0500 | No display for Specimen.collection.bodySite (concept: Structure of blood vessel of left upper arm (body structure))

Entry 55 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass2-blood-2

Resource Specimen:

> Profile: ACH Monthly Event Specimen

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798.32`/C104082902, `urn:oid:2.16.840.1.113883.19.5.1.798.800`/C10408290:42

> type: Venous blood specimen (specimen)

> subject: Pass1 ACH

> receivedTime: 2024-02-02 11:26:00-0500

> ### Collections

> - | Collected[x] | BodySite
> * | 2024-02-02 11:24:00-0500 | No display for Specimen.collection.bodySite (concept: Structure of blood vessel of left upper arm (body structure))

Entry 56 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-individual-ach-monthly-pass3

Resource MeasureReport:

> Profile: DEQM Individual MeasureReport Profile

> DEQM Measure Scoring Extension: Cohort

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Condition Acute sinusitis (disorder)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Condition Enterocolitis due to Clostridium difficile

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Coverage: identifier = Member Number: 0945345; status = active; type = preferred provider organization policy; subscriberId = 7843574536; relationship = Self

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051035 (use: usual, ); type = Intermittent venous compression system pump (physical object)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = finished; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = In-person encounter; period = 2024-02-02 16:43:00-0500 --> 2024-02-03 19:58:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = in-progress; class = short stay (ActCode[9.0.0]#SS); type = Hospital admission, elective (procedure); period = 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500; reasonCode = Diarrhea, unspecified

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = not-done; category = Inpatient; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; effective[x] = 2024-02-02 21:04:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888321 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-01 21:02:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888322 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-02 21:09:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888323 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-03 09:09:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Ciprofloxacin 500 MG; authoredOn = 2024-02-01 19:15:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Clostridioides difficile (organism)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Body height

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Observation Body weight

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Procedure Transfusion of red blood cells (procedure)

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay

> Measure Report Supplemental Data Element Reference (R5 surrogate extension): Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

> identifier: `http://example.org/fhir/measurereport/id`/123456789-pass3

> status: Complete

> type: Individual

> measure: NHSN dQM Acute Care Hospital Monthly Initial Populationversion: null1.0.0)

> subject: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))

> date: 2024-02-05 21:04:29+0000

> reporter: Organization Example NHSN Submitter

> period: 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000

> improvementNotation: Increased score indicates improvement

> > group

> > ### Populations

> > - | Code | Count
> > * | Initial Population | 1

> evaluatedResource:

> - Condition Acute sinusitis (disorder)
> - Condition Enterocolitis due to Clostridium difficile
> - Coverage: identifier = Member Number: 0945345; status = active; type = preferred provider organization policy; subscriberId = 7843574536; relationship = Self
> - Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051035 (use: usual, ); type = Intermittent venous compression system pump (physical object)
> - Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = finished; class = inpatient acute (ActCode[9.0.0]#ACUTE); type = In-person encounter; period = 2024-02-02 16:43:00-0500 --> 2024-02-03 19:58:00-0500
> - Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a (use: usual, ); status = in-progress; class = short stay (ActCode[9.0.0]#SS); type = Hospital admission, elective (procedure); period = 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500; reasonCode = Diarrhea, unspecified
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = not-done; category = Inpatient; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; effective[x] = 2024-02-02 21:04:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888321 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-01 21:02:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888322 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-02 21:09:00-0500
> - MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888323 (use: usual, ); status = completed; category = Inpatient; medication[x] = ->Metronidazole 500 MG; effective[x] = 2024-02-03 09:09:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual, ); status = active; intent = plan; category = Community; reported[x] = true; medication[x] = ->Ciprofloxacin 500 MG; authoredOn = 2024-02-01 19:15:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500
> - MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500
> - Observation Clostridioides difficile (organism)
> - Observation Body height
> - Observation Body weight
> - Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))
> - Procedure Transfusion of red blood cells (procedure)
> - ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay
> - Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 57 - fullUrl = http://nhsnlink.org/fhir/Patient/patient-example-ach-monthly-pass3

Resource Patient:

> Profile: Cross-Measure Patient Profile

> Security Label: Restricted (Details: Confidentiality code R = 'Restricted')

> Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> Active: | true
> Contact Detail | ACHtestcase@testcase.com 5678 Sesame Lansing Lansing MI 48864 US
> Language: | Chinese
> US Core Ethnicity Extension: | ombCategory: Race & Ethnicity - CDC 2186-5: Not Hispanic or Latino text: Non Hispanic or Latino
> US Core Birth Sex Extension | M
> US Core Race Extension: | ombCategory: Race & Ethnicity - CDC 2028-9: Asian text: White

Entry 58 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass3-acute

Resource Encounter:

> Profile: ACH Monthly Event Encounter

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005104253a (use: usual, )

> status: completed

> class: inpatient acute

> type: Critical care visit

> subject: Pass3 ACH

> ### Locations

> - | Location | Period
> * | ACH Monthly Medical Critical Care | 2024-02-02 16:43:00-0500 --> 2024-03-02 19:58:00-0500

Entry 59 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass3-short-stay

Resource Encounter:

> Profile: ACH Monthly Event Encounter

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/10005104253a (use: usual, )

> status: In Progress

> class: short stay

> type: Hospital Admission, Elective Procedure

> subject: Pass3 ACH

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Enterocolitis due to Clostridium difficile)

> ### Locations

> - | Location | Period
> * | ACH Monthly Medical-Surgical Ward | 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500

Entry 60 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ach-monthly-pass3

Resource Coverage:

> Profile: ACH Monthly Event Coverage

> identifier: Member Number/0945345

> status: Active

> type: preferred provider organization policy

> subscriberId: 7843574536

> beneficiary: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> relationship: Self

Entry 61 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass3-problem

Resource Condition:

> Profile: ACH Monthly Event Condition

> clinicalStatus: Resolved

> verificationStatus: Confirmed

> category: Problem List Item

> code: Acute sinusitis

> subject: Pass3 ACH

> onset: 2024-01-21 07:32:00-0500

> abatement: 2024-02-02 16:43:00-0500

Entry 62 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass3

Resource Condition:

> Profile: ACH Monthly Event Condition

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Encounter Diagnosis

> code: Enterocolitis due to Clostridium difficile

> subject: Pass3 ACH

Entry 63 - fullUrl = http://nhsnlink.org/fhir/Device/device-example-ach-monthly-pass3-ivcs-pump

Resource Device:

> Profile: ACH Monthly Event Device

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/100051035 (use: usual, )

> type: Intermittent venous compression system pump

Entry 64 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-enoxaparin

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888833 (use: usual, )

> status: not-done

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500

> ### Dosages

> - | Text | Site | Route | Dose
> * | 0.4ml subcutaneous once daily in abdomen | Subcutaneous tissue structure of anterior abdominal wall (body structure) | Oral | 4000 uL (Details: UCUM codeuL = 'uL')

Entry 65 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-1

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888321 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500

> ### Dosages

> - | Text | Route | Dose
> * | 5mg tablet by mouth twice daily | Oral | 5 mg (Details: UCUM codemg = 'mg')

Entry 66 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-2

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888322 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500

> ### Dosages

> - | Text | Route | Dose
> * | 5mg tablet by mouth twice daily | Oral | 5 mg (Details: UCUM codemg = 'mg')

Entry 67 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-3

Resource MedicationAdministration:

> Profile: ACH Monthly Event MedicationAdministration

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/1018888323 (use: usual, )

> status: completed

> category: Inpatient Medication

> subject: Pass2 ACH

> request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832 (use: usual, ); status = active; intent = order; category = Inpatient; reported[x] = false; medication[x] = ->Metronidazole 500 MG; authoredOn = 2024-02-01 20:33:00-0500

> ### Dosages

> - | Text | Route | Dose
> * | 5mg tablet by mouth twice daily | Oral | 5 mg (Details: UCUM codemg = 'mg')

Entry 68 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-cipro

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888892 (use: usual, )

> status: Active

> intent: Plan

> category: Home Medication

> subject: Pass2 ACH

> encounter: Short Stay

> authoredOn: 2024-02-01 19:15:00-0500

> requester: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> recorder: Patient Identified

> > dosageInstruction

> > text: 500mg tablet by mouth twice daily

> > timing: 2 per 1 day

> > route: Oral

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 500 mg (Details: UCUM codemg = 'mg')

Entry 69 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-enoxaparin

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888833 (use: usual, )

> status: Active

> intent: Order

> category: Inpatient Medication

> subject: Pass2 ACH

> encounter: Critical care visit

> authoredOn: 2024-02-02 12:21:00-0500

> requester: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> > dosageInstruction

> > text: 0.4ml subcutaneous once daily in abdomen

> > timing: Once per 1 day

> > site: Subcutaneous tissue structure of anterior abdominal wall (body structure)

> > route: Oral

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 4000 uL (Details: UCUM codeuL = 'uL')

Entry 70 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-metronidazole

Resource MedicationRequest:

> Profile: ACH Monthly Event MedicationRequest

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798`/101888832 (use: usual, )

> status: Active

> intent: Order

> category: Inpatient Medication

> subject: Pass2 ACH

> encounter: Short Stay

> authoredOn: 2024-02-01 20:33:00-0500

> requester: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN: 1601191903010308 (use: usual, ))

> > dosageInstruction

> > text: 5mg tablet by mouth twice daily

> > timing: 2 per 1 day

> > route: Oral

> > ### DoseAndRates

> > - | Type | Dose[x]
> > * | calculated | 5 mg (Details: UCUM codemg = 'mg')

Entry 71 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-cdiff

Resource Observation:

> Profile: ACH Monthly Event Lab Result Observation

> basedOn: ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay

> status: Final

> category: Laboratory

> code: C. Diff.

> subject: Pass3 ACH

> encounter: Hospital Admission, Short Stay

> effective: 2024-02-01 19:02:00-0500

> issued: 2024-02-02 15:30:00-0500

> value: Positive (qualifier value)

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 72 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-vitals-height

Resource Observation:

> Profile: ACH Monthly Event Observation - Vital Signs

> status: Final

> category: Vital Signs

> code: Height

> subject: Pass3 ACH

> encounter: Short Stay

> effective: 2024-02-01 19:21:00-0500

> issued: 2024-02-01 19:21:00-0500

> value: 176.8 cm (Details: UCUM codecm = 'cm')

Entry 73 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-vitals-weight

Resource Observation:

> Profile: ACH Monthly Event Observation - Vital Signs

> status: Final

> category: Vital Signs

> code: Weight

> subject: Pass3 ACH

> encounter: Short Stay

> effective: 2024-02-01 19:21:00-0500

> issued: 2024-02-01 19:21:00-0500

> value: 54.4 kg (Details: UCUM codekg = 'kg')

Entry 74 - fullUrl = http://nhsnlink.org/fhir/Procedure/procedure-example-ach-monthly-pass3-transfusion

Resource Procedure:

> Profile: ACH Monthly Event Procedure

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.698.8`/100051035264 (use: usual, )

> status: Completed

> code: Transfusion of red blood cells (procedure)

> subject: Pass3 ACH

> encounter: Critical care visit

Entry 75 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass3-cdiff

Resource ServiceRequest:

> Profile: ACH Monthly Event ServiceRequest

> identifier: Placer Identifier/1019631826 (use: usual, )

> status: Completed

> intent: Original Order

> category: Laboratory procedure

> code: No display for ServiceRequest.code (concept: Clostridioides difficile toxin A [Presence] in Stool by Immunoassay)

> quantity: 1

> subject: Pass3 ACH

> encounter: Hospital Admission, Short Stay

> occurrence: Code , Events: 2024-02-01 18:12:00-0500 , Count 1 times, Once

> authoredOn: 2024-02-01 18:12:00-0500

> specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 76 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass3-stool

Resource Specimen:

> Profile: ACH Monthly Event Specimen

> identifier: `urn:oid:2.16.840.1.113883.19.5.1.798.32`/C104082905, `urn:oid:2.16.840.1.113883.19.5.1.798.800`/C10408290:45

> type: Bloody stool specimen (specimen)

> subject: Pass3 ACH

> receivedTime: 2024-02-01 19:12:00-0500

> ### Collections

> - | Collected[x] | BodySite
> * | 2024-02-01 19:02:00-0500 | No display for Specimen.collection.bodySite (concept: Entire rectum (body structure))