Version 2.77

Term Description

The Patient Information Form (PIF) is used to collect demographic information as well as additional information about the impact of the event on a patient (e.g., level of harm, unplanned interventions). It supplements the Healthcare Event Reporting Form (HERF) in cases where an incident is being reported.
Source: Regenstrief LOINC

Panel Hierarchy

Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
74502-6 Patient Safety Event Report - Hospital: Patient Information Form - Version 1.2
Indent74081-1 Event ID: R 1..1
Indent30947-6 Initial Report Date (HERF Q1): R 1..1 {mm/dd/yyyy}
Indent74500-0 At the time of the event what was the patient's age? R 1..1
Indent74694-1 Is the patient's ethnicity Hispanic or Latino? R 1..1
Indent74693-3 What is the patient's race? R 1..1
Indent52797-8 ICD-9-CM or ICD-10-CM principal diagnosis code at discharge (if available): O 0..1
Indent74562-0 Was any intervention attempted in order to "rescue" the patient (i.e., to prevent, to minimize, or to reverse harm)? R 1..1
Indent74561-2 Which of the following interventions (rescue) were documented? C 1..1
Indent74560-4 After any intervention to reduce harm, what was the degree of residual harm to the patient from the incident (and subsequent intervention)? R 1..1
Indent74559-6 What is the anticipated duration of the harm to the patient? R 1..1
Indent74558-8 Approximately when after discovery of the incident was harm assessed? R 1..1
Indent74557-0 Did, or will, the incident result in an increased length of stay? R 1..1
Indent74556-2 After the discovery of the incident, was the patient, patient's family, or guardian notified? R 1..1

Fully-Specified Name

Component
Patient safety event report - hospital - patient information form - version 1.2
Property
-
Time
Pt
System
^Patient
Scale
-
Method
AHRQ

Basic Attributes

Class
PANEL.SURVEY.AHRQ
Type
Surveys
First Released
Version 2.48
Last Updated
Version 2.54
Panel Type
Panel

LOINC Terminology Service (API) using HL7® FHIR® Get Info

CodeSystem lookup
https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=74502-6
Questionnaire definition
https://fhir.loinc.org/Questionnaire/?url=http://loinc.org/q/74502-6