74502-6
Patient Safety Event Report - Hospital: Patient Information Form - Version 1.2
Active
74081-1 Event ID:
Observation ID in Form
DE2
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Patient safety event
- Property
- ID
- Time
- Pt
- System
- ^Event
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.46
- Last Updated
- Version 2.66
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74725-3 | Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ] |
| 74495-3 | Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ] |
| 74080-3 | Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ] |
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
| 74501-8 | Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ] |
30947-6 Initial Report Date (HERF Q1):
Observation ID in Form
DE30
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Date form completed
- Property
- Date
- Time
- Pt
- System
- Form
- Scale
- Qn
- Method
Additional Names
- Short Name
- Date form completed
Basic Attributes
- Class
- ADMIN
- Type
- Clinical
- First Released
- Version 2.04
- Last Updated
- Version 2.61
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 97887-4 | Core Outcome Measures Index for the Back [COMI] |
| 97327-1 | Core Outcome Measures Index for the Neck [COMI] |
| 69412-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0 |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 85671-6 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment] |
| 85662-5 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment] |
| 85668-2 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment] |
| 100203-9 | Knee Society Score post-op panel [Knee Society Score] |
| 100159-3 | Knee Society Score pre-op panel [Knee Society Score] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 101111-3 | MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
| 101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
| 101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 46611-0 | Mental residual functional capacity (RFC) assessment form |
| 74725-3 | Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ] |
| 74495-3 | Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ] |
| 74080-3 | Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ] |
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
| 74501-8 | Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ] |
| 60687-1 | Test of Infant Motor Performance Version 5.1 |
| 55140-8 | Vaccine Adverse Event Reporting System (VAERS) panel |
Language Variants Get Info
| Tag | Language | Translation |
|---|---|---|
| es-AR | Spanish (Argentina) | fecha de formulario completo: |
| es-MX | Spanish (Mexico) | Formulario de fecha completado: |
| it-IT | Italian (Italy) | Data completamento form: Synonyms: Amministrativo Punto nel tempo (episodio) |
| pt-BR | Portuguese (Brazil) | Data formulário preenchido: Synonyms: Time stamp; |
| ru-RU | Russian (Russian Federation) | Дата форма заполнение: Synonyms: Дата заполнения формы Количественный Точка во времени; |
| zh-CN | Chinese (China) | 表单完成日期: Synonyms: 可用数量表示的; |
Example Units
| Unit | Source |
|---|---|
| {mm/dd/yyyy} | Example UCUM Units |
74500-0 At the time of the event what was the patient's age?
Observation ID in Form
DE45
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Age at time of event
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- At the time of the event what was the patient's age?
- Source
- PIF.Q1
Normative Answer List LL2814-3
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Neonate (0-28 days) | a | LA20736-7 | |
| Infant (>28 days <1 year) | b | LA20737-5 | |
| Child (1-12 years) | c | LA20738-3 | |
| Adolescent (13-17 years) | d | LA20739-1 | |
| Adult (18-64 years) | e | LA20740-9 | |
| Mature adult (65-74 years) | f | LA20741-7 | |
| Older adult (75-84 years) | g | LA20742-5 | |
| Aged adult (85+ years) | h | LA20743-3 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | i | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74694-1 Is the patient's ethnicity Hispanic or Latino?
Observation ID in Form
DE48
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Ethnicity
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
HL7® Attributes
HL7® Field ID- PID-22
Survey Question
- Text
- Is the patient's ethnicity Hispanic or Latino?
- Source
- PIF.Q2
Normative Answer List LL2815-0
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Hispanic or Latino | a | LA6214-6 | |
| Not Hispanic or Latino | b | LA19555-4 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | c | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74693-3 What is the patient's race?
Observation ID in Form
DE51
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Race
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
HL7® Attributes
HL7® Field ID- PID-10
Survey Question
- Text
- What is the patient's race?
- Source
- PIF.Q3
Normative Answer List LL2816-8
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| American Indian or Alaska Native | a | LA6155-1 | |
| Asian | b | LA6156-9 | |
| Black or African American | c | LA10610-6 | |
| Native Hawaiian or Other Pacific Islander | d | LA10611-4 | |
| White | e | LA4457-3 | |
| More than one race | f | LA20744-1 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | g | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
52797-8 ICD-9-CM or ICD-10-CM principal diagnosis code at discharge (if available):
Observation ID in Form
DE54
Observation Required in Panel
Optional
Fully-Specified Name
- Component
- Diagnosis ICD code
- Property
- Prid
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Additional Names
- Short Name
- Dx ICD code
Basic Attributes
- Class
- CLIN
- Type
- Clinical
- First Released
- Version 2.26
- Last Updated
- Version 2.73
- Change Reason
- Changed CLASS from SURVEY.MDS to CLIN
- Order vs. Observation
- Both
- Common Test Rank Get Info
- 743
Example Answer List LL4547-7
- Externally Defined
- Yes
- Code System
- Code System OID
- 1.3.6.1.4.1.12009.10.1.3459
- Link to External List
- http://www.cdc.gov/nchs/icd.htm
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
| 52747-3 | Continuity Assessment Record and Evaluation (CARE) tool - Expired |
| 52745-7 | Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge |
| 52743-2 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care |
| 52748-1 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission |
| 52746-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim |
| 52744-0 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission |
| 83265-9 | Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment] |
| 87414-9 | Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment] |
| 88329-8 | Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment] |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 86522-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 86872-9 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment] |
| 86871-1 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment] |
| 86873-7 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment] |
| 86856-2 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment] |
| 86876-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment] |
| 88282-9 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88283-7 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment] |
| 88284-5 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment] |
| 88285-2 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment] |
| 88287-8 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment] |
| 88292-8 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment] |
| 88288-6 | Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment] |
| 88954-3 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88945-1 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment] |
| 88946-9 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment] |
| 88947-7 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment] |
| 88949-3 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment] |
| 88955-0 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment] |
| 88950-1 | Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment] |
| 89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
| 93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
| 87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
| 93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
| 90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 101111-3 | MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
| 101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 89724-9 | Minimum Data Set (MDS) for Public Health Emergency Operations Centers (EOC) [CDC Emergency Operations Centers] |
| 87825-6 | National Trauma Data Standard - version 2018 set |
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
| 62949-3 | PhenX domain - Gastrointestinal |
Language Variants Get Info
| Tag | Language | Translation |
|---|---|---|
| es-ES | Spanish (Spain) | Código CIE del diagnóstico: |
| es-MX | Spanish (Mexico) | Código ICD de diagnóstico: |
| it-IT | Italian (Italy) | Diagnosi, codice ICD: Synonyms: Clinico paziente Presenza o Identità Punto nel tempo (episodio) |
| zh-CN | Chinese (China) | 诊断 ICD 代码: Synonyms: ICD 分类型应答; |
74562-0 Was any intervention attempted in order to "rescue" the patient (i.e., to prevent, to minimize, or to reverse harm)?
Term Description
Determination if intervention was attempted to rescue the patient.
Source: Regenstrief LOINC
Observation ID in Form
DE63
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Rescue intervention was attempted
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- Was any intervention attempted in order to "rescue" the patient (i.e., to prevent, to minimize, or to reverse harm)?
- Source
- PIF.Q5
Normative Answer List LL2817-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | a | LA33-6 | |
| No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | b | LA32-8 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | c | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74561-2 Which of the following interventions (rescue) were documented?
Term Description
Determination of the interventions performed in order to rescue the patient.
Source: Regenstrief LOINC
Observation ID in Form
DE66
Observation Required in Panel
Conditional
Form Coding Instructions
Check all that apply:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Documented rescue interventions
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- Which of the following interventions (rescue) were documented?
- Source
- PIF.Q6
Normative Answer List LL2818-4
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Transfer, including transfer to a higher level care area within facility, transfer to another facility, or hospital admission (from outpatient) | a | LA20745-8 | |
| Monitoring, including observation, physiological examination, laboratory testing, phlebotomy, and/or imaging studies | b | LA20746-6 | |
| Medication therapy, including administration of antidote, change in pre-incident dose or route | c | LA21144-3 | |
| Surgical/procedural intervention | d | LA21145-0 | |
| Respiratory support (e.g., ventilation, tracheotomy) | e | LA21146-8 | |
| Blood transfusion | f | LA21147-6 | |
| Counseling or psychotherapy | g | LA21148-4 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | h | LA4489-6 | |
| Other intervention: PLEASE SPECIFY | i | LA21149-2 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74560-4 After any intervention to reduce harm, what was the degree of residual harm to the patient from the incident (and subsequent intervention)?
Term Description
The extent of harm to the patient after discovery of the incident and any attempts to minimize adverse consequences.
Source: Regenstrief LOINC
Observation ID in Form
DE55
Observation Required in Panel
Required
Form Coding Instructions
Check first applicable:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Extent of harm to the patient
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- After any intervention to reduce harm, what was the degree of residual harm to the patient from the incident (and subsequent intervention)?
- Source
- PIF.Q7
Normative Answer List LL2819-2
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Death: Dead at time of assessment. | a | LA20747-4 | |
| Severe harm: Bodily or psychological injury (including pain or disfigurement) that interferes significantly with functional ability or quality of life. | b | LA20748-2 | |
| Moderate harm: Bodily or psychological injury adversely affecting functional ability or quality of life, but not at the level of severe harm. | c | LA20749-0 | |
| Mild harm: Bodily or psychological injury resulting in minimal symptoms or loss of function, or injury limited to additional treatment, monitoring, and/or increased length of stay. | d | LA21150-0 | |
| No harm: Event reached patient, but no harm was evident. | e | LA21151-8 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | f | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74559-6 What is the anticipated duration of the harm to the patient?
Term Description
Determination of the anticipated duration of the harm to the patient.
Source: Regenstrief LOINC
Observation ID in Form
DE59
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Anticipated duration of harm to the patient
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- What is the anticipated duration of the harm to the patient?
- Source
- PIF.Q8
Normative Answer List LL2820-0
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Permanent: not expected to revert to approximately normal (i.e., patient's baseline) | a | LA20750-8 | |
| Temporary: expected to revert to approximately normal (i.e., patient's baseline) | b | LA20751-6 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | c | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74558-8 Approximately when after discovery of the incident was harm assessed?
Term Description
Determination of approximately when after the discovery of the incident the harm was assessed.
Source: Regenstrief LOINC
Observation ID in Form
DE60
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Timing of harm assessment
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- Approximately when after discovery of the incident was harm assessed?
- Source
- PIF.Q9
Normative Answer List LL2821-8
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Within 24 hours | a | LA20752-4 | |
| After 24 hours but before 3 days | b | LA20753-2 | |
| Three days or later | c | LA20754-0 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | d | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74557-0 Did, or will, the incident result in an increased length of stay?
Term Description
Determination if the incident resulted in an increased length of stay.
Source: Regenstrief LOINC
Observation ID in Form
DE69
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Increased length of stay due to incident
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- Did, or will, the incident result in an increased length of stay?
- Source
- PIF.Q10
Normative Answer List LL2822-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | a | LA33-6 | |
| No (or not anticipated) | b | LA20755-7 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | c | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
74556-2 After the discovery of the incident, was the patient, patient's family, or guardian notified?
Term Description
Determination if the patient, patient's family or guardian was notified of an incident.
Source: Regenstrief LOINC
Observation ID in Form
DE72
Observation Required in Panel
Required
Form Coding Instructions
Check one:
Source: Agency for Healthcare Research and QualityFully-Specified Name
- Component
- Family or guardian was notified
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
- AHRQ
Basic Attributes
- Class
- SURVEY.AHRQ
- Type
- Surveys
- First Released
- Version 2.48
- Last Updated
- Version 2.48
- Order vs. Observation
- Observation
Survey Question
- Text
- After the discovery of the incident, was the patient, patient's family, or guardian notified?
- Source
- PIF.Q11
Normative Answer List LL2817-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | a | LA33-6 | |
| No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | b | LA32-8 | |
| Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) | c | LA4489-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.