Full LTC Monthly Measure Submission Bundle - CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG v3.0.0

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Example Bundle: Full LTC Monthly Measure Submission Bundle

Profile: NHSN MeasureReport Bundle

Bundle bundle-example-ltc-monthly-full of type collection

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

Resource Organization:

Profile: NHSN Submitting Organization
Example NHSN Submitter (Healthcare Provider) (https://www.cdc.gov/nhsn/OrgID#ExampleNHSNSubmitterOrgID)
Active: true
Type: Healthcare Provider
Contact Detail
ph: 5555555551

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

Resource Device:

Profile: NHSN Submitting Device

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

Resource List:

Profile: Patients-Of-Interest List
Date: 2025-07-28 00:00:00+0000 Mode: Change List Status: Current
Items
Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))

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

Resource MeasureReport:

Profile: Subject-List MeasureReport Profile
status: Complete
type: Subject List
measure: NHSN Acute Care Hospital Daily Initial Population version: 3.0.0
date: 2022-09-01 23:59:59+0000
reporter: Example NHSN Submitter (Healthcare Provider) (https://www.cdc.gov/nhsn/OrgID#ExampleNHSNSubmitterOrgID)
period: 2022-08-01 00:00:00+0000 --> 2022-08-31 23:59:59+0000
group
DEQM Measure Scoring Extension: Cohort
Populations
- Code Count SubjectResults
* Initial Population 4 List for 'Unspecified List Type' for 'Unspecified Subject'

Profile: NHSN Individual MeasureReport List
Mode: Snapshot List Status: Current
Items
MeasureReport: extension = ->Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual)),Cohort,->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient acute (ActCode#ACUTE); type = Hospital Admission; period = 2024-02-01 16:02:00-0500 --> 2024-02-08 19:00:00-0500; reasonCode = Weakness,->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = in-progress; class = inpatient non-acute (ActCode#NONAC); type = Nursing Facility Visit; period = 2024-02-08 16:02:00-0500 --> 2024-02-11 19:00:00-0500; reasonCode = Pneumonia,->LTC Monthly Inpatient Hospital Ward (Medical ward) (http://www.example.com/location#2935),->LTC Monthly - Long Term Care Facility General Nursing Unit (Long Term Care Facility General Nursing Unit) (http://www.example.com/location#3001),->Coverage: identifier = Member Number: 335522612; status = active; type = subsidized health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing),->Condition Pneumonia, unspecified organism,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual); status = completed; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; effective[x] = 2024-01-31 04:54:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual); status = completed; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; effective[x] = 2024-02-02 14:34:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual); status = active; intent = plan; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; authoredOn = 2024-01-31 04:46:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual); status = completed; intent = order; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; authoredOn = 2024-02-02 13:43:00-0500,->Medication Amoxicillin 1000mg oral tablet,->Medication Levofloxacin 500mg Oral Tablet; identifier = http://example.org/fhir/measurereport/id#123456789-pneumonia; status = complete; type = individual; measure = http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalDailyInitialPopulation|3.0.0; date = 2024-01-06 21:04:29+0000; period = 2024-01-05 00:00:00+0000 --> 2024-01-06 00:00:00+0000; improvementNotation = Increased score indicates improvement
MeasureReport: extension = ->UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual)),Cohort,->Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient non-acute (ActCode#NONAC); type = Long-Term Care Visit; period = 2025-02-01 16:02:00-0500 --> 2029-02-08 19:00:00-0500; reasonCode = Dementia,->LTC Monthly - Long Term Care Facility General Nursing Unit (Long Term Care Facility General Nursing Unit) (http://www.example.com/location#3001),->Coverage: identifier = Member Number: 335522612; status = active; type = military health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing),->Condition Pneumonia, unspecified organism,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->ceftriaxone 1000 MG Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500,->MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; intent = order; category = Inpatient Medication; priority = stat; medication[x] = ->ceftriaxone 1 G Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500,->MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; effective[x] = 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 Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; authoredOn = 2024-02-01 12:00:00-0500,->Observation Urinalysis complete W Reflex Culture panel (U),->ServiceRequest Urinalysis complete W Reflex Culture panel (U),->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 = Urine specimen; receivedTime = 2024-02-02 18:20:00-0500,->Medication ceftriaxone 1000 MG Injection,->Medication Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; identifier = http://example.org/fhir/measurereport/id#123456789-uti; status = complete; type = individual; measure = http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalDailyInitialPopulation|3.0.0; date = 2024-01-06 21:04:29+0000; period = 2024-01-05 00:00:00+0000 --> 2024-01-06 00:00:00+0000; improvementNotation = Increased score indicates improvement

Entry 5 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-ltc-monthly-pneumonia

Resource MeasureReport:

Profiles: NHSN Individual MeasureReport, DEQM Individual MeasureReport Profile
Extension Definition for MeasureReport.supplementalData for Version 5.0: Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
Extension Definition for MeasureReport.supplementalData for Version 5.0: Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient acute (ActCode#ACUTE); type = Hospital Admission; period = 2024-02-01 16:02:00-0500 --> 2024-02-08 19:00:00-0500; reasonCode = Weakness
Extension Definition for MeasureReport.supplementalData for Version 5.0: Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = in-progress; class = inpatient non-acute (ActCode#NONAC); type = Nursing Facility Visit; period = 2024-02-08 16:02:00-0500 --> 2024-02-11 19:00:00-0500; reasonCode = Pneumonia
Extension Definition for MeasureReport.supplementalData for Version 5.0: LTC Monthly Inpatient Hospital Ward (Medical ward) (http://www.example.com/location#2935)
Extension Definition for MeasureReport.supplementalData for Version 5.0: LTC Monthly - Long Term Care Facility General Nursing Unit (Long Term Care Facility General Nursing Unit) (http://www.example.com/location#3001)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Coverage: identifier = Member Number: 335522612; status = active; type = subsidized health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Condition Pneumonia, unspecified organism
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual); status = completed; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; effective[x] = 2024-01-31 04:54:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual); status = completed; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; effective[x] = 2024-02-02 14:34:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual); status = active; intent = plan; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; authoredOn = 2024-01-31 04:46:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual); status = completed; intent = order; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; authoredOn = 2024-02-02 13:43:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: Medication Amoxicillin 1000mg oral tablet
Extension Definition for MeasureReport.supplementalData for Version 5.0: Medication Levofloxacin 500mg Oral Tablet
DEQM Measure Scoring Extension: Cohort
identifier: http://example.org/fhir/measurereport/id/123456789-pneumonia
status: Complete
type: Individual
measure: NHSN Acute Care Hospital Daily Initial Population version: 3.0.0
subject: Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
date: 2024-01-06 21:04:29+0000
reporter: Example NHSN Submitter (Healthcare Provider) (https://www.cdc.gov/nhsn/OrgID#ExampleNHSNSubmitterOrgID)
period: 2024-01-05 00:00:00+0000 --> 2024-01-06 00:00:00+0000
group
Populations
- Code Count
* Initial Population 1
evaluatedResource:
Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient acute (ActCode#ACUTE); type = Hospital Admission; period = 2024-02-01 16:02:00-0500 --> 2024-02-08 19:00:00-0500; reasonCode = Weakness
Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = in-progress; class = inpatient non-acute (ActCode#NONAC); type = Nursing Facility Visit; period = 2024-02-08 16:02:00-0500 --> 2024-02-11 19:00:00-0500; reasonCode = Pneumonia
Coverage: identifier = Member Number: 335522612; status = active; type = subsidized health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing)
Condition Pneumonia, unspecified organism
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888893 (use: usual); status = completed; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; effective[x] = 2024-01-31 04:54:00-0500
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888111 (use: usual); status = completed; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; effective[x] = 2024-02-02 14:34:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual); status = active; intent = plan; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; authoredOn = 2024-01-31 04:46:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual); status = completed; intent = order; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; authoredOn = 2024-02-02 13:43:00-0500
Medication Amoxicillin 1000mg oral tablet
Medication Levofloxacin 500mg Oral Tablet

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

Resource Patient:

Profile: Cross-Measure Patient Profile
Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
Active: true
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 7 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ltc-monthly-pneumonia-1

Resource Encounter:

Profile: LTC Monthly Event Encounter
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/10005104251 (use: usual)
status: completed
class: inpatient acute
type: Hospital Admission
subject: Pneumonia LTC
Diagnoses
- Condition
* No display for Encounter.diagnosis.condition (reference: ->Pneumonia)
Locations
- Location Period
* Inpatient Ward 2024-02-01 16:02:00-0500 --> 2024-02-08 16:02:00-0500

Entry 8 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ltc-monthly-pneumonia-2

Resource Encounter:

Profile: LTC Monthly Event Encounter
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/10005104251 (use: usual)
status: In Progress
class: inpatient non-acute
type: Nursing Facility Visit
subject: Pneumonia LTC
Diagnoses
- Condition
* No display for Encounter.diagnosis.condition (reference: ->Pneumonia)
Locations
- Location Period
* Inpatient Ward 2024-02-08 16:02:00-0500 --> 2024-02-11 16:02:00-0500

Entry 9 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ltc-monthly-pneumonia-medicare

Resource Coverage:

Profile: LTC Monthly Event Coverage
identifier: Member Number/335522612
status: Active
type: subsidized health program
subscriberId: 123123123123
beneficiary: Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
relationship: Self
period: 2020-08-01 --> (ongoing)

Entry 10 - fullUrl = http://nhsnlink.org/fhir/Organization/organization-coverage-example-ltc-monthly-medicare

Resource Organization:

Profile: QICore Organization version: 6.0.0
Medicare
Active: true

Entry 11 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ltc-monthly-pneumonia

Resource Condition:

Profile: QICore Condition Encounter Diagnosis version: 6.0.0
clinicalStatus: Active
verificationStatus: Confirmed
category: Encounter Diagnosis
code: Pneumonia, unspecified organism
subject: Pneumonia LTC

Entry 12 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ltc-monthly-pneumonia-amoxicillin

Resource MedicationAdministration:

Profile: LTC Monthly Event Medication Administration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888893 (use: usual)
status: completed
category: Outpatient
subject: Pneumonia LTC
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892 (use: usual); status = active; intent = plan; category = Outpatient; medication[x] = ->Amoxicillin 1000 MG; authoredOn = 2024-01-31 04:46:00-0500
Dosages
- Text Route Dose
* One Amoxicillin 1g dispersible tablet for oral use Oral 1 g (Details: UCUM codeg = 'g')

Entry 13 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ltc-monthly-pneumonia-levofloxacin

Resource MedicationAdministration:

Profile: LTC Monthly Event Medication Administration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/1018888111 (use: usual)
status: completed
category: Inpatient
subject: Pneumonia LTC
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888811 (use: usual); status = completed; intent = order; category = Inpatient; medication[x] = ->Levofloxacin 500 MG; authoredOn = 2024-02-02 13:43:00-0500
Dosages
- Text Route Dose
* 500 MG Oral Tablet once daily Oral route 500 MG (Details: UCUM codeMG = 'MG')

Entry 14 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ltc-monthly-pneumonia-amoxicillin

Resource MedicationRequest:

Profile: LTC Monthly Event Medication Request
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888892 (use: usual)
status: Active
intent: Plan
category: Outpatient
subject: Pneumonia LTC
encounter: Hospital Admission
authoredOn: 2024-01-31 04:46:00-0500
requester: Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
dosageInstruction

Entry 15 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ltc-monthly-pneumonia-levofloxacin

Resource MedicationRequest:

Profile: LTC Monthly Event Medication Request
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888811 (use: usual)
status: Completed
intent: Order
category: Inpatient
subject: Pneumonia LTC
encounter: Hospital Admission
authoredOn: 2024-02-02 13:43:00-0500
requester: Pneumonia LTC(official) Female, DoB: 1945-12-22 ( MRN: 1601191945010308 (use: usual))
dosageInstruction

Entry 16 - fullUrl = http://nhsnlink.org/fhir/Medication/medication-example-amoxicillin-1000

Resource Medication:

Profile: LTC Monthly Event Medication
code: Amoxicillin 1000mg oral tablet
status: Active

Entry 17 - fullUrl = http://nhsnlink.org/fhir/Medication/medication-example-levofloxacin-500

Resource Medication:

Profile: LTC Monthly Event Medication
code: Levofloxacin 500mg Oral Tablet
status: Active

Entry 18 - fullUrl = http://nhsnlink.org/fhir/Location/location-example-ltc-monthly-nursing-facility

Resource Location:

Profile: QICore Location version: 6.0.0
LTC Monthly - Long Term Care Facility General Nursing Unit (Long Term Care Facility General Nursing Unit) (http://www.example.com/location#3001)
Status: Active
Description:
LTC Monthly General Nursing Unit

Type: Long Term Care Facility General Nursing Unit

Entry 19 - fullUrl = http://nhsnlink.org/fhir/Location/location-example-ltc-monthly-inpatient

Resource Location:

Profile: QICore Location version: 6.0.0
LTC Monthly Inpatient Hospital Ward (Medical ward) (http://www.example.com/location#2935)
Status: Active
Description:
LTC Monthly Inpatient Hospital Ward

Type: Medical ward

Entry 20 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-ltc-monthly-uti

Resource MeasureReport:

Profiles: NHSN Individual MeasureReport, DEQM Individual MeasureReport Profile
Extension Definition for MeasureReport.supplementalData for Version 5.0: UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
Extension Definition for MeasureReport.supplementalData for Version 5.0: Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient non-acute (ActCode#NONAC); type = Long-Term Care Visit; period = 2025-02-01 16:02:00-0500 --> 2029-02-08 19:00:00-0500; reasonCode = Dementia
Extension Definition for MeasureReport.supplementalData for Version 5.0: LTC Monthly - Long Term Care Facility General Nursing Unit (Long Term Care Facility General Nursing Unit) (http://www.example.com/location#3001)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Coverage: identifier = Member Number: 335522612; status = active; type = military health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Condition Pneumonia, unspecified organism
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->ceftriaxone 1000 MG Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; intent = order; category = Inpatient Medication; priority = stat; medication[x] = ->ceftriaxone 1 G Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; effective[x] = 2024-02-01 12:00:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual); status = completed; intent = order; category = Inpatient Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; authoredOn = 2024-02-01 12:00:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: Observation Urinalysis complete W Reflex Culture panel (U)
Extension Definition for MeasureReport.supplementalData for Version 5.0: ServiceRequest Urinalysis complete W Reflex Culture panel (U)
Extension Definition for MeasureReport.supplementalData for Version 5.0: 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 = Urine specimen; receivedTime = 2024-02-02 18:20:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: Medication ceftriaxone 1000 MG Injection
Extension Definition for MeasureReport.supplementalData for Version 5.0: Medication Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet
DEQM Measure Scoring Extension: Cohort
identifier: http://example.org/fhir/measurereport/id/123456789-uti
status: Complete
type: Individual
measure: NHSN Acute Care Hospital Daily Initial Population version: 3.0.0
subject: UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
date: 2024-01-06 21:04:29+0000
reporter: Example NHSN Submitter (Healthcare Provider) (https://www.cdc.gov/nhsn/OrgID#ExampleNHSNSubmitterOrgID)
period: 2024-01-05 00:00:00+0000 --> 2024-01-06 00:00:00+0000
group
Populations
- Code Count
* Initial Population 1
evaluatedResource:
UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104251 (use: usual); status = finished; class = inpatient non-acute (ActCode#NONAC); type = Long-Term Care Visit; period = 2025-02-01 16:02:00-0500 --> 2029-02-08 19:00:00-0500; reasonCode = Dementia
Coverage: identifier = Member Number: 335522612; status = active; type = military health program; subscriberId = 123123123123; relationship = Self; period = 2020-08-01 --> (ongoing)
Condition Pneumonia, unspecified organism
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->ceftriaxone 1000 MG Prefilled Syringe; effective[x] = 2024-02-01 12:22:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; intent = order; category = Inpatient Medication; priority = stat; medication[x] = ->ceftriaxone 1 G Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888942 (use: usual); status = completed; category = Inpatient Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; effective[x] = 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 Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; authoredOn = 2024-02-01 12:00:00-0500
Observation Urinalysis complete W Reflex Culture panel (U)
ServiceRequest Urinalysis complete W Reflex Culture panel (U)
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 = Urine specimen; receivedTime = 2024-02-02 18:20:00-0500
Medication ceftriaxone 1000 MG Injection
Medication Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet

Entry 21 - fullUrl = http://nhsnlink.org/fhir/Patient/patient-example-ltc-monthly-uti

Resource Patient:

Profile: Cross-Measure Patient Profile
UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (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:
Son LTC
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 22 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ltc-monthly-uti

Resource Encounter:

Profile: LTC Monthly Event Encounter
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/10005104251 (use: usual)
status: completed
class: inpatient non-acute
type: Long-Term Care Visit
subject: UTI LTC
Diagnoses
- Condition
* No display for Encounter.diagnosis.condition (reference: ->Dementia)
Locations
- Location Period
* Long-Term Care Facility 2025-02-01 16:02:00-0500 --> 2029-02-08 16:02:00-0500

Entry 23 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ltc-monthly-uti-tricare

Resource Coverage:

Profile: LTC Monthly Event Coverage
identifier: Member Number/335522612
status: Active
type: military health program
subscriberId: 123123123123
beneficiary: UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
relationship: Self
period: 2020-08-01 --> (ongoing)

Entry 24 - fullUrl = http://nhsnlink.org/fhir/Organization/organization-coverage-example-ltc-monthly-tricare

Resource Organization:

Profile: QICore Organization version: 6.0.0
Tricare (Champus)
Active: true

Entry 25 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ltc-monthly-uti

Resource Condition:

Profile: QICore Condition Encounter Diagnosis version: 6.0.0
clinicalStatus: Active
verificationStatus: Confirmed
category: Encounter Diagnosis
code: Pneumonia, unspecified organism
subject: Pneumonia LTC

Entry 26 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ltc-monthly-uti-ceftriaxone

Resource MedicationAdministration:

Profile: LTC Monthly Event Medication Administration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888895 (use: usual)
status: completed
category: Inpatient Medication
subject: UTI LTC
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888895 (use: usual); status = completed; intent = order; category = Inpatient Medication; priority = stat; medication[x] = ->ceftriaxone 1 G Prefilled Syringe; authoredOn = 2024-02-01 12:00:00-0500
Dosages
- Text Site Route Dose
* ceftriaxone 1000 MG IV Left arm IV 1 G (Details: UCUM codeG = 'G')

Entry 27 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ltc-monthly-uti-ceftriaxone

Resource MedicationRequest:

Profile: LTC Monthly Event Medication Request
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888895 (use: usual)
status: Completed
intent: Order
category: Inpatient Medication
priority: STAT
subject: UTI LTC
encounter: Hospital Admission
authoredOn: 2024-02-01 12:00:00-0500
requester: UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
dosageInstruction

Entry 28 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ltc-monthly-uti-trimethoprim

Resource MedicationAdministration:

Profile: LTC Monthly Event Medication Administration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/1018888942 (use: usual)
status: completed
category: Inpatient Medication
subject: UTI LTC
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888894 (use: usual); status = completed; intent = order; category = Inpatient Medication; medication[x] = ->Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet; authoredOn = 2024-02-01 12:00:00-0500
Dosages
- Text Site Route Dose
* Sulfamethoxazole 800 mg / Trimethoprim 160 mg by mouth twice daily for 3 days Oral cavity structure (body structure) Oral 800 MG

Entry 29 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ltc-monthly-uti-trimethoprim

Resource MedicationRequest:

Profile: LTC Monthly Event Medication Request
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888894 (use: usual)
status: Completed
intent: Order
category: Inpatient Medication
subject: UTI LTC
encounter: Hospital Admission
authoredOn: 2024-02-01 12:00:00-0500
requester: UTI LTC(official) Female, DoB: 1953-02-01 ( MRN: 1601191901018808 (use: usual))
dosageInstruction

Entry 30 - fullUrl = http://nhsnlink.org/fhir/Observation/lab-observation-example-ltc-monthly-uti-urinalysis

Resource Observation:

Profile: LTC Monthly Event Lab Result Observation
basedOn: ServiceRequest Urinalysis complete W Reflex Culture panel (U)
status: Final
category: Laboratory
code: Urinalysis complete W Reflex Culture panel (U)
subject: UTI LTC
encounter: Hospital Admission
effective: 2024-02-02 18:12:00-0500
issued: 2024-02-03 11:42:00-0500
value: Culture result showed >100,000 CFU/mL of Escherichia coli (E. coli)
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 = Urine specimen; receivedTime = 2024-02-02 18:20:00-0500

Entry 31 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ltc-monthly-uti-urinalysis

Resource ServiceRequest:

Profile: QICore ServiceRequest version: 6.0.0
identifier: Placer Identifier/1019631821 (use: usual)
status: Completed
intent: Original Order
category: Laboratory procedure
code: No display for ServiceRequest.code (concept: Urinalysis complete W Reflex Culture panel (U))
quantity: 1
subject: UTI LTC
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

Entry 32 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ltc-monthly-uti-urine

Resource Specimen:

Profile: LTC 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: Urine specimen
subject: UTI LTC
receivedTime: 2024-02-02 18:20:00-0500
Collections
- Collected[x]
* 2024-02-02 18:12:00-0500

Entry 33 - fullUrl = http://nhsnlink.org/fhir/Medication/medication-example-ceftriaxone-1000

Resource Medication:

Profile: LTC Monthly Event Medication
code: ceftriaxone 1000 MG Injection
status: Active

Entry 34 - fullUrl = http://nhsnlink.org/fhir/Medication/medication-example-trimethoprim

Resource Medication:

Profile: LTC Monthly Event Medication
code: Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet
status: Active