Version 2.77

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:marca de tiempo:fecha y hora:punto en el tiempo:forma:cuantitativo:
es-MX Spanish (Mexico) Formulario de fecha completado:Fecha:Punto temporal:Formulario:Cuantitativo:
it-IT Italian (Italy) Data completamento form:Data:Pt:Modulo:Qn:
Synonyms: Amministrativo Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Data formulário preenchido:TmStp:Pt:Forma:Qn:
Synonyms: Time stamp; Date and time; Timestamp; Point in time; Random; Quantitative; QNT; Quant; Quan; VACCINE
ru-RU Russian (Russian Federation) Дата форма заполнение:Дата:ТчкВрм:Форма:Колич:
Synonyms: Дата заполнения формы Количественный Точка во времени;Момент
zh-CN Chinese (China) 表单完成日期:日期:时间点:表单:定量型:
Synonyms: 可用数量表示的;定量性;数值型;数量型;连续数值型标尺 日子;几号 时刻;随机;随意;瞬间 行政;管理;施行;执行;经营 表单填写日期 表格;表;窗体

Example Units

Unit Source
{mm/dd/yyyy} Example UCUM Units

74076-1 What type of medication/substance was involved?

Observation ID in Form

DE270

Observation Required in Panel

Required

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Medication or substance involved
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What type of medication/substance was involved?
Source
Medications.Q1

Normative Answer List LL2654-3

Answer Code Score Answer ID
Medications a LA20271-5
Biological products b LA20335-8
Nutritional products c LA20336-6
Expressed human breast milk d LA20337-4
Medical gases (e.g., oxygen, nitrogen, nitrous oxide) e LA20338-2
Contrast media f LA20339-0
Radiopharmaceuticals g LA20340-8
Patient food (not suspected in drug-food interactions) h LA20341-6
Drug-drug, drug-food, or adverse drug reaction as a result of a prescription and/or administration of a drug and/or food prior to admission i LA20342-4
Other substance: PLEASE SPECIFY j LA20343-2

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74075-3 What type of medication?

Observation ID in Form

DE273

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Medication
Property
Type
Time
Pt
System
Medication
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What type of medication?
Source
Medications.Q2

Normative Answer List LL2655-0

Answer Code Score Answer ID
Prescription or over-the-counter (including herbal supplements) a LA20278-0
Compounded preparations b LA20298-8
Investigational drugs c LA20299-6
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) d LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74077-9 Please list all ingredients:

Observation ID in Form

DE276

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Ingredients for compounded preparations
Property
Find
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q3

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74074-6 What type of biological product?

Observation ID in Form

DE279

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Biological product
Property
Type
Time
Pt
System
Medication
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What type of biological product?
Source
Medications.Q4

Normative Answer List LL2657-6

Answer Code Score Answer ID
Vaccines a LA20283-0
Other biological products (e.g., thrombolytic) b LA20287-1

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

30959-1 Lot number [Identifier] Vaccine

Observation ID in Form

DE282

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Lot number
Property
ID
Time
Pt
System
Vaccine
Scale
Nom
Method

Additional Names

Short Name
Lot # Vaccine

Basic Attributes

Class
VACCIN
Type
Clinical
First Released
Version 2.04
Last Updated
Version 2.27
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
39294-4 Children's preventive health services attachment Set
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
85701-1 Rubella surveillance panel
55140-8 Vaccine Adverse Event Reporting System (VAERS) panel

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Numero de lote:ID:Punto temporal:Vacuna:Nominal:
es-AR Spanish (Argentina) número de lote:intradérmico:punto en el tiempo:vacuna:Nominal:
it-IT Italian (Italy) Lotto, codice:ID:Pt:Vaccino:Nom:
Synonyms: Codice lotto Identificatore Punto nel tempo (episodio) Vaccinazioni
nl-NL Dutch (Netherlands) lotnummer:identificator:moment:vaccin:nominaal:
pt-BR Portuguese (Brazil) Número do lote:ID:Pt:Vacina:Nom:
Synonyms: Num; No; Lot #; Identifier; Ident; Point in time; Random; Nominal
ru-RU Russian (Russian Federation) Партия номер:ID:ТчкВрм:Вакцина:Ном:
Synonyms: Идентификатор Номер партии Номинальный;Именной Точка во времени;Момент
zh-CN Chinese (China) 批号:标识符:时间点:疫苗:名义型:
Synonyms: 个数;数目 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 接种;接种记录;疫苗;疫苗接种 时刻;随机;随意;瞬间 标识;身份标识符;身份标识

74073-8 What type of nutritional product?

Observation ID in Form

DE285

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Type of nutritional product
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What type of nutritional product?
Source
Medications.Q6

Normative Answer List LL2659-2

Answer Code Score Answer ID
Dietary supplements (other than vitamins or minerals) a LA20273-1
Vitamins or minerals b LA16117-6
Enteral nutritional products, including infant formula c LA20320-0
Parenteral nutritional products d LA20321-8
Other: PLEASE SPECIFY e LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74072-0 Which of the following best characterizes the event?

Observation ID in Form

DE288

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Best characterization of medication or other substance event
Property
Find
Time
Pt
System
^Event
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Which of the following best characterizes the event?
Source
Medications.Q7

Normative Answer List LL2660-0

Answer Code Score Answer ID
Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication) a LA20275-6
Unsafe condition b LA20314-3
Adverse reaction in patient to the administered substance without any apparent incorrect action c LA20315-0
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) d LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74071-2 What was the incorrect action?

Observation ID in Form

DE291

Observation Required in Panel

Conditional

Form Coding Instructions

Check all that apply:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Incorrect action
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What was the incorrect action?
Source
Medications.Q8

Normative Answer List LL2661-8

Answer Code Score Answer ID
Incorrect patient a LA20276-4
Incorrect medication/substance b LA20302-8
Incorrect dose(s) c LA20303-6
Incorrect route of administration d LA20304-4
Incorrect timing e LA20305-1
Incorrect rate f LA20306-9
Incorrect duration of administration or course of therapy g LA20307-7
Incorrect dosage form (e.g., sustained release instead of immediate release) h LA20308-5
Incorrect strength or concentration i LA20309-3
Incorrect preparation, including inappropriate cutting of tablets, error in compounding, mixing, etc. j LA20310-1
Expired or deteriorated medication/substance k LA20311-9
Medication/substance that is known to be an allergen to the patient l LA20312-7
Medication/substance that is known to be contraindicated for the patient m LA20345-7
Incorrect patient/family action (e.g., self-administration error) n LA20313-5
Other: PLEASE SPECIFY o LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74070-4 Which best describes the incorrect dose(s)?

Observation ID in Form

DE294

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Best description for the incorrect dose
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Which best describes the incorrect dose(s)?
Source
Medications.Q9

Normative Answer List LL2662-6

Answer Code Score Answer ID
Overdose a LA20277-2
Underdose b LA20300-2
Missed or omitted dose c LA20301-0
Extra dose d LA7271-5
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) e LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74069-6 Which best describes the incorrect timing?

Observation ID in Form

DE297

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Best description for the incorrect timing
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Which best describes the incorrect timing?
Source
Medications.Q10

Normative Answer List LL2663-4

Answer Code Score Answer ID
Too early a LA20280-6
Too late b LA20290-5
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) c LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74068-8 Which best describes the incorrect rate?

Observation ID in Form

DE300

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Best description for the incorrect rate
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Which best describes the incorrect rate?
Source
Medications.Q11

Normative Answer List LL2664-2

Answer Code Score Answer ID
Too quickly a LA20282-2
Too slowly b LA20288-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) c LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74067-0 Which best describes the incorrect strength or concentration?

Observation ID in Form

DE303

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Best description for incorrect strength or concentration
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Which best describes the incorrect strength or concentration?
Source
Medications.Q12

Normative Answer List LL2665-9

Answer Code Score Answer ID
Too high a LA20281-4
Too low b LA20289-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) c LA4489-6

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74066-2 What was the expiration date?

Observation ID in Form

DE306

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Expiration date
Property
Date
Time
Pt
System
Medication
Scale
Qn
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.50
Order vs. Observation
Observation

Survey Question

Text
What was the expiration date?
Source
Medications.Q13

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

Example Units

Unit Source
{mm/dd/yyyy} Example UCUM Units

74065-4 Was there a documented history of allergies or sensitivities to the medication/substance administered?

Observation ID in Form

DE309

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
History of allergies or sensitivities to the medication or substance administered was documented
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Was there a documented history of allergies or sensitivities to the medication/substance administered?
Source
Medications.Q14

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
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74064-7 What was the contraindication (potential or actual interaction)?

Observation ID in Form

DE312

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Medication or substance contraindication - potential or actual interaction
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What was the contraindication (potential or actual interaction)?
Source
Medications.Q15

Normative Answer List LL2668-3

Answer Code Score Answer ID
Drug-drug a LA20274-9
Drug-food b LA20316-8
Drug-disease c LA20317-6
Other: PLEASE SPECIFY d LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74063-9 At what stage in the process did the event originate, regardless of the stage at which it was discovered?

Observation ID in Form

DE315

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Stage in the process that the event originated, regardless of the stage at which it was discovered
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
At what stage in the process did the event originate, regardless of the stage at which it was discovered?
Source
Medications.Q16

Normative Answer List LL2669-1

Answer Code Score Answer ID
Purchasing a LA20279-8
Storing b LA20291-3
Prescribing/ordering c LA20292-1
Transcribing d LA20293-9
Preparing e LA20294-7
Dispensing f LA20295-4
Administering g LA20296-2
Monitoring h LA20297-0
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) i LA4489-6
Other: PLEASE SPECIFY j LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74078-7 Medication or other substance details panel [AHRQ]

Observation Required in Panel

Conditional

Form Coding Instructions

Please provide the following medication details for any medications or other substances directly involved in the event.

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Medication or other substance details panel
Property
-
Time
Pt
System
Medication
Scale
-
Method
AHRQ

Basic Attributes

Class
PANEL.SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Subset
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74062-1 Generic name or investigational drug name

Observation ID in Form

DE318

Observation Required in Panel

Required

Fully-Specified Name

Component
Generic or investigational drug name
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q17

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74061-3 Ingredient RXCUI (if known)

Observation ID in Form

DE319

Observation Required in Panel

Optional

Fully-Specified Name

Component
Ingredient - RxNorm RXCUI
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q18

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
85057-8 PCORnet Common Data Model set - version 3.0 [PCORnet]

74060-5 Brand name (if known)

Observation ID in Form

DE321

Observation Required in Panel

Optional

Fully-Specified Name

Component
Brand name
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q19

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74059-7 Brand name RXCUI (if known)

Observation ID in Form

DE322

Observation Required in Panel

Optional

Fully-Specified Name

Component
Brand name - RxNorm RXCUI
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q20

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
85057-8 PCORnet Common Data Model set - version 3.0 [PCORnet]

74058-9 Manufacturer (if known)

Observation ID in Form

DE324

Observation Required in Panel

Optional

Fully-Specified Name

Component
Manufacturer name
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q21

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74057-1 Strength or concentration of product

Term Description

Medication strength is based on the amount of active ingredient present in each dosage.
Source: Regenstrief LOINC

Observation ID in Form

DE327

Observation Required in Panel

Required

Fully-Specified Name

Component
Medication strength
Property
Dosage
Time
Pt
System
Medication
Scale
Qn
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.58
Order vs. Observation
Observation

Survey Question

Source
Medications.Q22

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74056-3 Clinical drug component RXCUI (if known)

Term Description

The Clinical drug component (RxNorm RXCUI) is the ingredient plus strength (e.g....)
Source: Regenstrief LOINC

Observation ID in Form

DE328

Observation Required in Panel

Optional

Fully-Specified Name

Component
Clinical drug component - RxNorm RXCUI
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Source
Medications.Q23

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
85057-8 PCORnet Common Data Model set - version 3.0 [PCORnet]

74055-5 Dosage form of product

Observation ID in Form

DE330

Observation Required in Panel

Required

Fully-Specified Name

Component
Dose form
Property
Type
Time
Pt
System
Medication
Scale
Nom
Method

Additional Names

Short Name
Dose form Medication

Basic Attributes

Class
MEDS
Type
Clinical
First Released
Version 2.46
Last Updated
Version 2.58
Order vs. Observation
Observation

Survey Question

Source
Medications.Q24

Example Answer List LL3146-9

Answer Code Score Answer ID
Pill LA16247-1
Tablet LA21908-1
Capsule LA21907-3
Extended-release capsule LA21911-5
Granules LA21912-3
Suspension LA21913-1
Elixir LA21914-9
Cream LA21915-6
Ointment LA21916-4
Injectable solution LA21917-2
Patch LA21918-0
Spray LA21919-8

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
85038-8 Somatotropin monitoring panel

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Forma de dosis:Tipo:Punto temporal:Medicamento:Nominal:
it-IT Italian (Italy) Dose, forma:Tipo:Pt:Farmaco:Nom:
Synonyms: Medicazione Punto nel tempo (episodio)
ru-RU Russian (Russian Federation) Доза форма:Тип:ТчкВрм:Лекарственный препарат:Ном:
Synonyms: Номинальный;Именной Точка во времени;Момент Форма выпуска
zh-CN Chinese (China) 剂型:类型:时间点:药物:名义型:
Synonyms: 一剂物质 一剂药物 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 剂量物质 型 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 时刻;随机;随意;瞬间 药剂形式 药物;药物处理;用药;使用药物 表格;表;窗体

74054-8 Dose form RXCUI (if known)

Observation ID in Form

DE331

Observation Required in Panel

Optional

Fully-Specified Name

Component
Dose form - RxNorm RXCUI
Property
ID
Time
Pt
System
Medication
Scale
Nom
Method

Additional Names

Short Name
Dose form RxNorm RXCUI Medication

Basic Attributes

Class
MEDS
Type
Clinical
First Released
Version 2.46
Last Updated
Version 2.58
Order vs. Observation
Observation

Survey Question

Source
Medications.Q25

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Forma de dosis - RxNorm RXCUI:ID:Punto temporal:Medicamento:Nominal:
it-IT Italian (Italy) Dose, forma - RxNorm RXCUI:ID:Pt:Farmaco:Nom:
Synonyms: Identificatore Medicazione Punto nel tempo (episodio)
ru-RU Russian (Russian Federation) Лекарственная форма - RxNorm RXCUI:ID:ТчкВрм:Лекарственный препарат:Ном:
Synonyms: Идентификатор Номинальный;Именной Точка во времени;Момент Форма выпуска
zh-CN Chinese (China) 剂型 - RxNorm RXCUI:标识符:时间点:药物:名义型:
Synonyms: 一剂物质 一剂药物 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 剂型 - RxNorm 唯一性概念标识符;剂型 - RxNorm 概念唯一性标识符 剂量物质 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 时刻;随机;随意;瞬间 标识;身份标识符;身份标识 药剂形式 药物;药物处理;用药;使用药物 表格;表;窗体

74053-0 Was this medication/ substance prescribed for this patient?

Observation ID in Form

DE333

Observation Required in Panel

Required

Fully-Specified Name

Component
Medication or substance was prescribed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Was this medication/ substance prescribed for this patient?
Source
Medications.Q26

Normative Answer List LL2828-3

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

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74052-2 Was this medication / substance given to this patient?

Observation ID in Form

DE336

Observation Required in Panel

Required

Fully-Specified Name

Component
Medication or substance was given
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
Was this medication / substance given to this patient?
Source
Medications.Q27

Normative Answer List LL2828-3

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

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74051-4 What was the intended route of administration?

Observation ID in Form

DE348

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Intended route of administration
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What was the intended route of administration?
Source
Medications.Q28

Normative Answer List LL2682-4

Answer Code Score Answer ID
Cutaneous, topical application, including ointment, spray, patch a LA20272-3
Subcutaneous b LA9451-1
Ophthalmic c LA9444-6
Oral, including sublingual or buccal d LA20324-2
Otic e LA9445-3
Nasal f LA9263-0
Inhalation g LA9427-1
Intravenous h LA9437-0
Intramuscular i LA9429-7
Intrathecal j LA9435-4
Epidural k LA9418-0
Gastric l LA20332-5
Rectal m LA9369-5
Vaginal n LA9459-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) o LA4489-6
Other: PLEASE SPECIFY p LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]

74050-6 What was the actual route of administration (attempted or completed)?

Observation ID in Form

DE351

Observation Required in Panel

Conditional

Form Coding Instructions

Check one:

Source: Agency for Healthcare Research and Quality

Fully-Specified Name

Component
Actual route of administration - attempted or completed
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
AHRQ

Basic Attributes

Class
SURVEY.AHRQ
Type
Surveys
First Released
Version 2.46
Last Updated
Version 2.48
Order vs. Observation
Observation

Survey Question

Text
What was the actual route of administration (attempted or completed)?
Source
Medications.Q29

Normative Answer List LL2682-4

Answer Code Score Answer ID
Cutaneous, topical application, including ointment, spray, patch a LA20272-3
Subcutaneous b LA9451-1
Ophthalmic c LA9444-6
Oral, including sublingual or buccal d LA20324-2
Otic e LA9445-3
Nasal f LA9263-0
Inhalation g LA9427-1
Intravenous h LA9437-0
Intramuscular i LA9429-7
Intrathecal j LA9435-4
Epidural k LA9418-0
Gastric l LA20332-5
Rectal m LA9369-5
Vaginal n LA9459-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) o LA4489-6
Other: PLEASE SPECIFY p LA20318-4

Member of these Panels

LOINC Long Common Name
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]