NHDS - Alternate Procedure Hospitals Locating Medical Records Manual

National Hospital Discharge Survey

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NHDS - Alternate Procedure Hospitals Locating Medical Records Manual

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National Hospital
Discharge Survey: 2007

Hospital Manual

USCENSUSBUREAU

U.S. Department of Commerce

Economics and Statistics Administration
U.S. CENSUS BUREAU

Helping You Make Informed Decisions

Disclaimer: All patient, provider, and hospital names
in this manual are fictitious.

HDS-101

HOSPITAL NAME:___________________________________________________________
HOSPITAL NUMBER (NCHS): _________________________________________________
SAMPLE KEY:

___________________________________________________________

SAMPLING LIST: ___________________________________________________________
Questions concerning the survey can be made to the NHDS Supervisor at the Regional Office
of the U. S. Census Bureau at the number(s) or by e-mail below.
Telephone: ______________________________1-800 number:______________________
NHDS Supervisor: ____________________________________________________________
Regional Office Name and Address:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
E-Mail Address: ______________________________________________________________

Table of Contents
Page
Chapter 1

Description of the National Hospital Discharge Survey

.................................. 1

Chapter 2

Selecting Sample Medical Records .................................................................... 7

Chapter 3

Abstracting of Medical Records ....................................................................... 21

Chapter 4

Transmitting Data and Correspondence ........................................................... 41

Chapter 5

Providing NHDS Data by Computer Printouts ................................................ 45

Chapter 6

Providing NHDS Data in Machine Readable Form............................................ 63

Appendices:
A:
B:
C:
D:
E:
F:
G:
H:
I:
J:
K:

Form HDS-5, Sample Listing Sheet .........................................................................
Form HDS-1, Medical Abstract ................................................................................
Examples of Discharge Summaries ..........................................................................
Sources of Payment (Item C-16) .............................................................................
Form HDS-3, Transmittal Notice .............................................................................
Examples of Acceptable Printout Formats F1-F3 ....................................................
Example of Code Sheet for Printouts .......................................................................
Example of HDS-5 for Printout Hospitals ................................................................
Example of HDS-3 Transmittal Form for Printout Hospitals .................................
File Layout for Providing Case-Mix Patient Data via Machine Readable Data……
Example of HDS-3A Transmittal Notice for Hospitals Supplying Machine
Readable Data………………………………………………………………………

71
73
75
77
79
81
85
87
89
91
97

Records Not Available Table .................................................................................................... 99

HDS-101

January 2007

Chapter 1
Description of the National Hospital Discharge Survey

Topic

See Page

Overview

HDS Data

HDS-101

January 2007

Topic 1. Overview
Background

The National Hospital Discharge Survey (NHDS) is the principal
source for national data on the characteristics of patients
discharged from non-Federal short-stay hospitals. Data from
NHDS are used to examine important topics of interest in public
health and for a variety of activities by governmental, scientific,
academic, and commercial institutions.
The NHDS has been conducted continuously by the National
Center for Health Statistics (NCHS), Centers for Disease Control
and Prevention, since 1965. The U. S. Census Bureau is
responsible for collecting the data and managing many aspects of
the survey.

Purpose of NHDS

The NHDS produces national estimates of the use of non-Federal
short-stay U. S. hospitals. The survey provides information on:
•
•
•
•

Scope of NHDS

Patient characteristics
Lengths of stay
Diagnoses and surgical and diagnostic procedures
Patterns of use of care in hospitals of different size and
ownership and in various regions of the country.

Only hospitals with an average length of stay of fewer than 30 days
for all patients, general hospitals, or children’s general hospitals
are included in the survey. Federal, military, and Department of
Veterans Affairs hospitals, as well as hospital units of institutions
(such as prison hospitals), and hospitals with fewer than six beds
staffed for patient use are excluded.

HDS-101

January 2007

Topic 1. Overview, Continued
Sample Design

Since 1988, the NHDS sample has been a 3-stage design which
includes:
$

a sample of primary sampling units (PSUs) that covers the
50 states and the District of Columbia. (A PSU consists of
a county, a small group of contiguous counties, or a
Metropolitan Statistical Area.)

a sample of all short-stay and general non-Federal hospitals
within PSUs.

a sample of the discharges from the sampled hospitals.

To ensure that the hospital sample adequately reflects the nation,
hospitals are added periodically from lists of newly-opened
hospitals.

Legal Authority

The NCHS is the Federal Government’s principal health statistics
agency. The initial basis for NCHS surveys is the National Health
Survey Act (Public Law 84-652) enacted by Congress on July 3,
1956. This Act calls for a continuing health survey and special
studies on the Nation’s health. Public Law 84-652 was codified
later as Title 42, United States Code, Section 242k. The Census
Bureau is conducting this work under the authority of Title 15,
United States Code, Section 1525, in accordance with Title 31,
United States Code, Section 1501(a)(1).

Confidentiality

All information obtained in this survey that would permit
identification of an individual or hospital is held strictly
confidential, seen only by persons engaged in the National
Hospital Discharge Survey or related studies carried out by the
National Center for Health Statistics, Centers for Disease Control
and Prevention and not disclosed or released to others or used for
any other purpose (Section 308(d) of the Public Health Service
3

HDS-101

January 2007

Act) (Title 42, United States Code, Section 242(m)).

Topic 1. Overview, Continued

Confidentiality,
Continued

The Health Insurance Portability and Accountability Act of 1996
(HIPAA) and its Privacy Rule which went into effect April 14,
2003, have further ensured the privacy of the respondent’s
participation in the NHDS. Medical Record Numbers or other
needed identification are used to locate the sample cases, but they
are not released to the Census Bureau or to the sponsoring agency.
In addition, Section 513 of the Confidential Information Protection
and Statistical Efficiency Act or CIPSEA (Title 5 of Public Law
107-347) includes provisions for a felony conviction and/or fine of
up to $250,000 if NCHS staff violates the confidentiality
provisions.
If hospitals need additional information on measures taken about
this survey and conformance with HIPAA regulations, please
contact the Census Bureau staff.

HDS-101

January 2007

Topic 2. NHDS Data
Flow of Transmission

Sample hospitals send NHDS data to one of the regional offices of
the U. S. Census Bureau. After editing and reviewing, Census
sends the data to the NCHS who codes, processes, analyzes, and
publishes the data.

Release of Data

The NCHS publishes annual reports on characteristics of patients
and hospitals, and special reports on average lengths of stay,
DRGs, specific diagnoses, ownership, sources of payment and so
on.
Also, the NHDS Web site at:
www.cdc.gov/nchs/about/major/hdasd/nhds.htm
contains extensive information on and data from the NHDS as well
as downloadable reports and public use files.

Uses and Users

The NHDS data are used for research, planning, evaluation studies
and other activities by:
•

Hospitals and Medical Research Laboratories;

•

Universities and Medical Schools;

•

Professional organizations, such as the American Medical
Association, American Hospital Association, World Health
Organization;

•

Federal agencies such as the National Institutes of Health,
Health Care Financing Administration, Centers for Disease
Control and Prevention, Indian Health Service;

•

Others–Pharmaceutical and medical supply manufacturers,
publishing houses, market research groups, insurance
companies.

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January 2007

NOTES

HDS-101

January 2007

Chapter 2
Selecting Sample Medical Records

Topic
1.

See Page

Establish List Needed for
Sampling

Sample Key

Listing the Sample

Supplemental HDS-5

Alternate Sampling Procedure

HDS-101

January 2007

Topic 1. Establish List Needed For Sampling
Introduction

The first step in collecting NHDS data is to select a sample of
discharges from a list of all discharges for the month.
Note: If your hospital is approved to supply NHDS data by:

Sample List

Computer printouts, refer to Chapter 5, Providing NHDS
Data By Computer Printouts.

Machine readable data such as reel tape, cartridge tape,
CD-ROM, 3½” disk, or E-mail, refer to Chapter 6,
Providing NHDS Data in Machine Readable Form.

To select the sample each month, use a complete listing of all
patients discharged or admitted during that month.
The NCHS prefers that a discharge listing be used for sampling;
however, if the Census Bureau supervisor determined that an
admission or other listing is more appropriate for your hospital,
this will be noted inside the front cover of this manual under
“Sampling List.”
Regardless of which listing you are to use, it must contain:
1.

The date of discharge (or admission)

The medical record number–this is used only for locating
the sample records. This number is not released to Census
or to the NCHS.

Any other information needed to locate the sample medical
record

Use the listing to select the NHDS sample each month. If it
becomes necessary to use a different listing, note the reason for
this change on Form HDS-3, Transmittal (see Chapter 4 for
instructions on the HDS-3).
8

HDS-101

January 2007

Topic 2. Sample Key
Introduction

The sample key, also called terminal digit, designates the medical
records to select for the NHDS sample. The sample key for this
hospital is shown on the inside front cover of this manual.

How to use

If your hospital uses a non-biased medical record number or other
patient identification number, such as a patient account number,
select for the NHDS sample the records on the discharge (or
admission) listing with medical record or other identification
numbers that end with the number(s) in your sample key.

Example:

The sample key is “05.” Select all medical records
with numbers that end in 05, such as 434405,
434605, 435005A, and so on. Disregard any
alphabetical suffix or prefix and refer only to the
numbers.

If your hospital assigns numbers in a ‘biased’ manner, such as
designating certain groups of numbers to special units only, or has
no numbering system, use the Alternate Sampling Procedure as
described in Topic 5 of this chapter. The NHDS Supervisor at the
Census Regional Office will advise you of which sampling
procedure to use.

HDS-101

January 2007

Topic 3. Listing the Sample
Form HDS-5

Use Form HDS-5, Sample Listing Sheet, to list the sample of
medical records that you select from the discharge or admissions
list. The HDS-5 is a four-part form on NCR (no carbon required)
paper. The top copy (white) will contain medical record numbers
and possibly other personal identifying information which will not
appear on the other copies. To assure patient confidentiality, the
top copy will be retained by the hospital.
Prepare a separate set of listing sheets for each month. See
Appendix A for an example.

Completing the HDS-5
Heading

In Section A, Hospital, enter the name and number of the hospital
as shown on the inside front cover of this manual. Then enter the
name of the list used to select the sample medical records.
In Section B, Statistical Data, enter the following:
1.

Total Beds. Enter the number of inpatient beds in the
hospital on the last day of the month for which the sample
is selected. Exclude bassinets for newborn infants and beds
used only for emergency service or by the staff. A bed is
any bed, crib, or pediatric bassinet set up and regularly
maintained for use by inpatients, not including bassinets
available for newborns.

Total Admissions. If an admissions list is used to select the
sample, enter the total number of inpatient admissions for
the month, excluding the in-hospital births. If a discharge
list is used, leave this item blank.

Live Births. Enter the total number of live births delivered
at the hospital during the sample month. If none, enter ‘0’.

HDS-101

January 2007

Topic 3. Listing the Sample, Continued
Completing the HDS-5
Heading, Continued

Total discharges. If a discharge list is used to select the
sample, enter the total number of inpatient discharges for
the month, including deaths and newborn infants. If an
admissions list is used, leave this item blank.

In Section C, Sampling, enter:

Completing the HDS-5
Columns 1-5

Month. Enter the month and year for which the sample is
being selected.

Key. Enter the sample key number(s) for the hospital as
shown on the inside front cover of this manual.

Number in Sample. Fill this after you complete the sample
selection for the month. Enter the total number of medical
records listed on the HDS-5 for the month.

Sample selected by. Enter your name, title, and date you
selected the sample.

Column 1, HDS Number: assign consecutive, 4-digit numbers to
each sample medical record listed. Begin with ‘0001’ and
continue numbering to ‘1000.’ Then repeat the pattern.
Example:

In February you selected 25 medical records and
assigned numbers 0301-0325. In March, begin
numbering with 0326. When you get to 1000, begin
the next number with 0001.

Do not begin renumbering at the beginning of each year.
There may be occasions where records may have been omitted for
a sample month and need to be added to the HDS-5. For example,
if four records need to be added to the February listing above,
number these four records, ‘9301, 9302, 9303, 9304.’
11

HDS-101

January 2007

Topic 3. Listing the Sample, Continued
Completing the HDS-5
Columns 1-5, Continued

There also may be occasions where an HDS Number has been
duplicated. In these cases, enter a ‘9’ as the first digit of the
duplicate number. For example:

The first few numbers in Column 1
are listed as follows:

Change the duplicate HDS Number
‘0003’ to ‘9003’

HDS
number
(1)

0001

0002

0003

9003

0004

0005

Note: When abstracting the above case, enter the ‘9’ in the first box in Item A2 on the
HDS-1 (see page 26, HDS number):
9 0 0 3

HDS-101

January 2007

Topic 3. Listing the Sample, Continued
Completing the HDS-5
Columns 1-5, Continued
Column 2, Date of Discharge (or Admission): Enter the day (in
2-digit numerals) the patient was discharged from (or admitted to)
the hospital for each sampled medical record listed. This identifies
the particular stay sampled. For example, the patient was
discharged on the fifth of the month–enter ‘05’; if discharged on
the 30th–enter ‘30.’
Also at the top of this column, line through ‘(or admission)’ if a
discharge list is used or line through ‘Date of Discharge’ if an
admissions list is used.
*Column 3, Medical Record Number: Enter the complete
medical record number to which you applied the sample key for
each selected medical record.
*Column 4, Other Identification: If a number other than the
medical record number was used for selecting the records, enter
this number as appropriate. This can be a patient identification
number, billing number or other number. If no other number was
used, leave this column blank.
Also, if your hospital needs the patient’s name in addition to the
medical record number or other number in order to find the
appropriate medical record, enter the name in the space provided.
Note: If you use a number other than the medical record number
to select the sample records, be sure to enter the medical
record number in column 3 as well as the number (or name)
recorded in column 4.
*The Medical Record Number in Column 3 and Other
Identification in Column 4 are not released to the Census
Bureau or NCHS. This information is for sampling and
hospital use only.

HDS-101

January 2007

Topic 3. Listing the Sample, Continued
Completing the HDS-5
Columns 1-5, Continued

Completing the HDS-5
Sheet Number

Column 5, Date abstracted (or out-of-scope reason):
Fill this column during abstracting to indicate the date you
complete the HDS-1, Medical Abstract, for the sample medical
records, or the reason it was not completed. For a discussion of
reasons why an HDS-1 would not be completed, see Topic 2 of
Chapter 3.

Enter the number of Sample Listing Sheets completed for the
month in the upper right corner. If you complete 2, enter
‘1’ of ‘2’ on the first sheet, then ‘2’ of ‘2’ on the second sheet.
After you enter all of the sample cases, review each sheet. If a
case was missed, enter it on the next available line. Make any
corrections and additions to all copies.

HDS-101

January 2007

Topic 4. Supplemental HDS-5
Introduction

You will need to prepare a supplemental HDS-5 listing sheet only
if your hospital does not assign separate medical records or other
identification numbers to live-born infants. This is a very rare
event. In most hospitals, a separate medical record number is
assigned to newborn infants, therefore making them eligible for
sampling.

Supplemental HDS-5

If a separate medical record number is not assigned for live births
and the mother’s medical record is selected for the NHDS, make a
supplemental Sample Listing Sheet for newborns as follows:
$

Enter ‘Supplemental’ across the top of a blank HDS-5.

Complete Sections A-C.

Assign to the infant in column 1 the mother’s HDS Number
with a ‘6’ as the leading digit (i.e., 6088).

Enter the mother’s medical record number in column 3.
Note: This is for the hospital’s use only.

Make any other required entries in columns 2 and 4.

If you sample from an admissions list, enter the infant’s date of
birth for date of admissions. If you sample from a discharge list,
enter the baby’s actual date of discharge.
Include the supplemental listing sheets with the regular listing
sheets.

HDS-101

January 2007

Topic 5. Alternate Sampling Procedure
General

Some hospitals may not be able to use the Sample Key to select the
NHDS sample as outlined in Topic 3. These are:
$

Hospitals where there is no continuity of assigned numbers
from day-to-day; that is, the first admission each day is not
assigned a medical record number consecutive with the last
number assigned the previous day.

Hospitals where each department in the hospital has its own
block of numbers to be assigned only to patients admitted
to that unit. Since there is no assurance that all numbers in
all blocks will be used each month, the terminal digits
cannot be applied to these numbers for selecting the
sample.
For example, Patients in Cardiac Care are assigned
numbers 00-49. All other patients are assigned numbers
50-99. If the sampling key numbers were 37 and 47 and no
more than 36 patients were admitted to Cardiac Care, there
could be no sample cases. Also, with these terminal digits,
all the sample cases that could be included in the sample
would be from Cardiac Care and thus not be representative
of the entire hospital.

Alternate Sampling
Procedures

Hospitals that do not assign medical record or any other
type of patient identification numbers.

Hospitals described above may have to use the ‘Modified Terminal
Digit’ or ‘Random Start’ methods for sampling. If your hospital
assigns biased numbers as described above, call the NHDS
Supervisor named on the inside front cover of this manual.
Together, you can determine which sampling procedure is
appropriate for your hospital.

HDS-101

January 2007

Topic 5. Alternate Sampling Procedure, Continued
Modified Terminal Digit
Method

If you are instructed to use the Modified Terminal Digit Method
for sampling:
1.

Complete the heading items of the HDS-5, Sample Listing
Sheet as described in Topic 3 of this chapter.

Use the discharge (or admissions) list to obtain the monthly
sample.

By hand, number the discharges (or admissions).

Apply the sample key (listed on the inside front cover of
this manual) to the hand-listed numbers. List the selected
cases, date of discharge (or admission) and other items
needed to locate the sample record in columns 1-5 of the
HDS-5. See Topic 3 on completing Columns 1-5.

Make a notation at the bottom of the HDS-5 where to begin
the next month’s numbering by hand. After reaching 1,000
by hand, start with ‘1’ for the next discharge (or
admission).

The next page contains an example of selecting the NHDS
sample using the Modified Terminal Digit Method.

HDS-101

January 2007

Topic 5. Alternate Sampling Procedure, Continued
The following is an example of sampling using the Modified Terminal Digit Method. The
sample key numbers are 2, 5, 7 and 9. After obtaining the monthly listing, number each
discharge by hand. Then place a checkmark or circle all numbers that end with one of the
sample keys. List these discharges on the HDS-5, Sample Listing Sheet. *Note: Medical
Record Numbers are not released to Census or to the NCHS.
January Discharge List
Date of Discharge

*Medical Record Number

1-1

9336201

1-1

9336203

1-3

9336301

1-3

9336005

U 5

1-4

9336103

1-5

9336501

U 7

1-6

9400101

1-8

9400709

U 9

1-10

9336502

1-11

9400102

1-11

9400909

U 12

1-12

9401022

1-15

9401002

1-16

9401501

U 15

1-18

9401405

1-20

9402001

U 17

1-23

9401401

1-25

9402002

U 19

1-28

9402008

1-31

9402802

Note: at the bottom of the HDS-5, note to begin numbering the February discharges with ‘21.’

HDS-101

January 2007

Topic 5. Alternate Sampling Procedures, Continued
Random Start Method

If you are instructed to use the ‘Random Start Method,’ the NHDS
Supervisor will provide you with ‘start with’ and ‘take every’
numbers. Enter these as the Sample Key shown on the inside the
front cover of this manual.
1.

Complete the heading items of the HDS-5, Sample Listing
Sheet, as described in Topic 3.

Use the discharge (or admissions) list to obtain the monthly
sample.

The first time you use this method to select the NHDS
sample and when sampling January discharges (or
admissions), count down to the ‘start with’ number. Next
to this number, put an “X”, a checkmark or circle the
number to indicate that this is a selected record.

Beginning with the next record on the listing, count down
to the ‘take every’ and indicate it as selected. Continue
counting off this ‘take every’ until all appropriate records
on the month’s listing are selected.

List the indicated discharges (admissions) in Columns 1-5
of the HDS-5. See Topic 3 on completing Columns 1-5.

Make a notation at the bottom of the HDS-5 of the “End
Count,” that is, the number counted to for the last record on
that month’s listing. This will tell you where to begin your
‘take every’ count for the next month.

The next page contains an example of selecting the NHDS
sample using the Random Start Method.

HDS-101

January 2007

Topic 5. Alternate Sampling Procedure, Continued
The following is an example of sampling using the Random Start Method. The Start With
number is 2 and the Take Every interval is 3. The first sample case will be the second discharge
and every third discharge thereafter. *Note: Medical Record Numbers are not released to
Census or to the NCHS.
January Discharge List
Date of Discharge

Start With÷

End Count=3

*Medical Record Number

1-1

9336201

1-1

9336203

1-3

9336301

1-3

9336005

1-4

9336103

1-5

9336501

1-6

9400101

1-8

9400709

1-10

9336502

1-11

9400102

1-11

9400909

1-12

9401022

1-15

9401002

1-16

9401501

1-18

9401405

1-20

9402001

1-23

9401401

1-25

9402002

1-28

9402008
9402802

1-31

Note: at the bottom of the HDS-5, the end count is 3, so start counting for the ‘take every’ with 1
for February.

HDS-101

January 2007

Chapter 3
Abstracting of Medical Records

Topic

See Page

Locate the Medical Records

Abstract Complete Records
and Correct Stays

Abstracting Sources

Completing the HDS-1

Submitting Completed
Abstracts

HDS-101

January 2007

Topic 1. Locate the Medical Records
Introduction

After selecting the NHDS sample for a month, the next step in data
collection is to abstract certain information from each medical
record onto a Form HDS-1, Medical Abstract. An example of a
completed HDS-1 is in Appendix B.

Locate the Records

Using the completed HDS-5, Sample Listing Sheet, locate the
sample medical records. If a record is not available at this time,
enter “NA” in column 5 of the HDS-5 for the appropriate case and
list in the “Records Not Available” table in the back of this
manual.
Using the “Records Not Available” table, obtain any records for
the current data year that were not completed during previous
months if they are now available. Do not obtain any records for
previous data years.

Records Unable to Locate If you are unable to locate a medical record because an incorrect
number is entered on the discharge (or admission) list or you
misread the number on the list:
1.

Determine which medical record should be included in the
sample and locate that record for abstracting.

If the number or other identification on this record is
different from that recorded on the HDS-5 Sample List,
footnote the correct number (or other identification) at the
bottom of the HDS-5, but do not change the number (or
other identification) on the HDS-5.

Complete an HDS-1 Medical Abstract for this record

HDS-101

January 2007

Topic 2. Abstract Complete Records and Correct Stays
Abstract Complete
In-Scope Records Only

Out-of-Scope Records

Only abstract complete in-scope medical records. For NHDS, a
medical record is complete when the physician has signed the
record and entered the final diagnoses and operations or
procedures. Enter the date you complete the HDS-1 in column 5
of the HDS-5. The following are considered in-scope:
$

People admitted, assigned a bed, then discharged later that
day or at a later date, with or without approval.

Newborn infants born alive.

Inpatients discharged because of death.

Inpatients discharged or transferred to another short-term
hospital, or to a long-term institution, such as a nursing
home.

Patients discharged and transferred to another unit within
the hospital, such as a nursing home unit, psychiatric unit,
and so on.

The following patients are ineligible for the NHDS. Do not
complete an HDS-1 (dummy record) abstract; instead, note the outof-scope reason in column 5 of the HDS-5 for the appropriate case.
$

Persons dead on arrival (DOA).

Fetal deaths or stillbirths (Fetal).

Patients who die in the emergency room or in the operating
room without having been admitted either before or after
death (Emergency).

Patients given a pass to leave the hospital for a short period
of time but not actually discharged from the hospital (Pass).

Patients transferred from one service or room to another but
not actually discharged from the unit or hospital (Transfer).

Outpatients.

Same-day surgery patients.
23

HDS-101

January 2007

Topic 2. Abstract Complete Records and Correct Stays, Continued
Incomplete or Records
Not Available

Note all incomplete (Inc) or not available (NA) records in the
“Records Not Available” table at the back of this manual. Indicate
“Inc” or “NA” in Column 5 of the HDS-5 as appropriate.
As records become complete or available, abstract the needed
information and line through them in the “Records not Available”
table. We call these ‘back records.’

Abstract Correct Stays

If different hospital stays are in the patient’s medical record, refer
to the date of discharge (or admission) on the HDS-5 in order to
abstract the correct hospital stay.
Do not complete an HDS-1 if the actual discharge (or admission)
date on the recorded is not within the sampled month. In column 5
on the HDS-5, enter ‘not in sample month’ as the reason for not
completing an abstract form.

HDS-101

January 2007

Topic 3. Abstracting Sources
Introduction

Sources for the
HDS-1

You may use several sources in the medical record to complete the
HDS-1 Medical Abstract. The HDS-1 has four sections–
Sections A, B and C are called the nonmedical portions and
Section D is called the medical portion.
Sections A, B and C obtain data on patient identification,
characteristics and administrative information. Complete these
sections from the face sheet of the medical record. The face sheet
consists of the first sheet(s) in the medical record containing
information to identify the patient and key aspects of the
hospitalization.
Note: If the face sheet does not have the information to complete
Sections A, B and C, use other sources as appropriate to
obtain the missing data. If the missing information cannot
be obtained from any sources, mark the “Not Stated” box if
the item has one; otherwise, follow the instructions in
Topic 4.
Section D obtains information on patient diagnoses and
procedures. Complete these sections from the discharge summary
(or discharge sheet) if possible. A discharge summary contains a
complete summary of the patient’s condition and the events that
transpired during the hospitalization. It usually follows the face
sheet and may be typed or handwritten.
Use the discharge summary only if the diagnoses and/or
procedures are specifically identified and clearly summarized.
Appendix C shows examples of acceptable and unacceptable
discharge summary entries.
Note: If the medical record does not contain a discharge
summary, use the face sheet, physician attestation report or
DRG sheet to complete Section D. If you cannot complete
this section from any of these sources, enter “N/A” for not
available in items 17, 18, and 19.

HDS-101

January 2007

Topic 4. Completing the HDS-1
Getting Started

Completing Section A,
Patient Identification

To perform abstracting, you need a Form HDS-1, Medical
Abstract, the previously filled Form HDS-5, Sample Listing Sheet,
and the appropriate medical record (see Topic 1 on locating the
medical record).

Item 1, Hospital Number: Transcribe your hospital number
from the inside cover of this manual to the boxes provided. Enter a
‘zero’ in the first box followed by the three-digit number.
Item 2, HDS Number: Transcribe the HDS Number for the
sample medical record from column 1 on the HDS-5 to the boxes
provided.
Item 3, Item deleted: No entry required.
Item 4, Date of Admission: Transcribe the date the patient was
admitted for the selected hospital stay. Use two-digit numbers to
record the month and day and four digits for the year. For
example:
The admission date is May 23, 2007. Enter ‘05-23-2007.’
For newborn infants, enter the date of birth for the date of
admission.
If an admissions list was used to select the sample, make sure the
admission date on the medical record agrees with the date on the
Sample Listing Sheet. If not, resolve the problem as described in
Topic 2 of this chapter.

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section A,
Patient Identification,
Continued

Item 5, Date of Discharge: Transcribe the date the patient was
discharged from the hospital for the selected hospital stay. Use
two-digit numbers to record the month and day and four digits for
the year. For example:
The discharge is May 29, 2007. Enter ‘05-29-2007.’
If the discharge list was used to select the sample, make sure the
discharge date on the medical record agrees with the date on the
Sample Listing Sheet. If not, resolve the problem as described in
Topic 2 of this chapter.

Note: If the dates of admission and discharge are the same,
check to see if this was an inpatient or outpatient. If an
outpatient, the record is out-of-scope. Do not complete an
HDS-1; enter the out-of-scope reason in column 5 of the HDS-5
for this case.
Item 6, Residence ZIP Code: Enter the patient’s 5-digit ZIP
Code. If not indicated, enter an “X” in the first box.

Completing Section B,
Patient Characteristics

Item 7, Date of Birth: Enter the patient’s date of birth using two
digits for the month and day and four digits for the year. For
example:
The birth date is June 22, 1932. Enter ‘06-22-1932.’

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section B,
Patient Characteristics,
Continued

Item 8, Age: Enter the patient’s age only if the complete birth
date is not available. Make an entry in each units box. For
example:
For age 65, enter ‘065’; Age 2, enter ‘002’;
Age 103, enter ‘103.’
Also, mark one of the boxes to the right to indicate the period of
the age:
‘Years’ for patients 1 year and over
‘Months’ for children 30 days to 1 year
‘Days’ for infants less than 30 days old
Item 9, Sex: Mark the appropriate box.
Item 10, Ethnicity: Refers to the national or cultural group from
which a person is descended, and is determined by the nationality
or lineage of a parent, grandparent or other ancestors. Ethnicity is
not necessarily related to one’s race. Consider race and ethnicity
as two independent characteristics. Do not base a person’s ethnic
background on the name or the birthplace.
Mark Box 1, Hispanic or Latino if the patient is of Cuban,
Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race. The term, “Spanish
Origin” can be used in addition to “Hispanic or Latino.”
Mark Box 2, Not Hispanic or Latino if the patient’s descent is
other than a Hispanic or Latino.
Mark Box 3, Not Stated if the patient’s ethnicity is not indicated,
or if the ethnicity is not clearly specified.

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section B,
Patient Characteristics,
Continued

Item 11, Race:
Mark Box 1, White if the patient is white, Caucasian or has origins
in any of the original peoples of Europe, the Middle East or North
Africa.
Mark Box 2, Black or African American if the patient has origins
in any of the black racial groups of Africa. Terms such as
‘Haitian’ or ‘Negro’ can be used in addition to ‘Black or African
American.’
Mark Box 3, American Indian or Alaska Native if the patient has
origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation
or community attachment.
Mark Box 4, Asian if a patient has origins in any of the original
peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, Philippine Islands, Thailand, and Vietnam.
Mark Box 5, Native Hawaiian or Other Pacific Islander if the
patient has origins in any of the original people of Hawaii, Guam,
Samoa, or other Pacific Islands.
Mark Box 6, Other if the patient’s race does not fall into a category
described above. Enter the race on the lines provided.
Mark Box 7, Not stated if the patient’s race is not indicated, or if
the race is marked ‘Hispanic’ and no other racial information is
provided.

Note: If the record states TWO or more races,
mark all appropriate boxes.
If the record states “Asian/Pacific Islander”,
mark box 7, not stated.
29

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section B,
Patient Characteristics,
Continued

Completing Section C,
Administrative Info

Item 12, Marital Status: Mark the appropriate box. If not
indicated, mark ‘Not Stated.’ For newborns, always mark ‘Single”
regardless of whether or not the record states this.

Item 13, Type of Admission:
Mark Box 1, Emergency if the patient required immediate medical
intervention as a result of severe life threatening or potentially
disabling conditions. Patient generally is admitted through the
Emergency Room.
Mark Box 2, Urgent if the patient required immediate care and
treatment of a physical or mental disorder. Patient generally is
admitted to the first available and suitable accommodation.
Mark Box 3, Elective if the patient’s condition permitted adequate
time to schedule the availability of a suitable accommodation.
Mark Box 4, Newborn if the baby was born within the facility.
Mark Box 5, Item not available/Unknown if the admission type for
the patient is not available.

Item 14, Source of Admission:
Mark Box 1, Physician referral if the patient was admitted to this
facility upon the recommendation of his/her personal physician.
Mark Box 2, Clinical referral if the patient was admitted to this
facility upon recommendation of the facility’s clinic physician.
Mark Box 3, HMO Referral if the patient was admitted to this
facility upon the recommendation of a health maintenance
organization physician.
30

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

Mark Box 4, Transfer from a Hospital if the patient was admitted
to this facility as a transfer from an acute care facility where he/she
was an inpatient.
Mark Box 5, Transfer from SNF if the patient was admitted to this
facility as a transfer from a skilled nursing facility where he/she
was an inpatient.
Mark Box 6, Transfer from other health facility if the patient was
admitted to this facility as a transfer from a health care facility
other than an acute care facility or a skilled nursing facility. This
includes transfers from nursing homes, long-term care facilities,
and SNF patients who are at a non-skilled level of care.
Mark Box 7, Emergency Room if the patient was admitted to this
facility upon the recommendation of this facility’s emergency
room physician.
Mark Box 8, Court/Law Enforcement if the patient was admitted to
this facility upon the direction of a court of law, or upon the
request of a law enforcement agency representative.
Mark Box 9, Other if the patient was admitted to this facility for a
reason other than those categorized above, for example, newborn,
transfer from a Rural Primary Care Hospital, etc. Specify the
reason in the space provided.
Mark Box 10, Item not available if the information for the source
of admission to this facility is not available for the patient.

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

Item 15, Status/Disposition of patient: Mark the appropriate
box(es) as follows.
Box 1, Alive if the patient was alive upon discharge. Then mark
the appropriate disposition category as indicated:
a.

Routine discharge/discharged home for patients who were
discharged to return home. Include all patients referred to
home care services, specialty clinics, family physician, home
health care IV provider, or discharged to a relative, foster
home, or transferred to a corrections institute.

Left against medical advice for patients who refused further
medical care and left the hospital regardless of whether a
release of responsibility statement was signed or not. Also,
include those patients who left without informing any
members of the medical staff.

Discharged, transferred to another short-term hospital for all
patients who were transferred to another short-term hospital.
Include all short-term maternity hospitals.

Discharged, transferred to long-term care institution for all
patients who were transferred or returned to a nursing home,
skilled nursing facility (SNF), an extended care facility, an
intermediate care facility (ICF), or a custodial care facility.

Other disposition/not stated if the discharge status of the
patient is ‘alive’ and the disposition is unknown or patient is
transferred to other facility and the type of facility cannot be
classified as short-term or long-term. Include in this category
patients transferred to a state facility, psychiatric facility,
terminal care/hospice facility, rehabilitation facility or
specialty hospital.

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

Box 2, Died for patients who died after being admitted to the
hospital.
Box 3, Status not stated if no information on the patient’s
discharge status is indicated.

Item 16, Expected source(s) of payment:
Mark the ‘Principal’ and/or ‘Other additional sources’ for the
expected method of payment for this hospitalization. The
following are some general instructions.
$

Only mark one payment source in the Principal column.

If the medical record indicates only one payment source,
mark only the ‘Principal’ column. Leave the “Other
additional sources’ column blank.

If the medical record indicates two or more payment
sources and one is designated as the primary source, mark
the ‘Principal’ column for this source and the “Other
additional sources’ column for the remaining sources of
payment.

•

If the record indicates two or more payment sources but
none is designated as the principal source, mark the “Other
additional sources” column for all indicated sources,
leaving the ‘Principal’ column blank.

•

If you are uncertain about a specific government source,
mark “Other government payments.”

•

If you are uncertain about a specific private source, mark
“Other private or commercial insurance.”

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

●

If you are uncertain about placing a payment source in a
specific category, that is, government, private or other, mark
box 10, “Other” in the appropriate column and enter the
source in the space provided.

Note: Before marking one of the ‘Other’ categories outlined
above, refer to Appendix D at the back of this manual
which lists a number of sources of payment and the
appropriate box numbers to mark in Item C-16.
$

If there are two or more sources of payment and one source
is ‘self pay’, self pay cannot be the principal source of
payment.

If the patient’s expected source(s) of payment is not
indicated, mark the “No source of payment indicated’ box.

If the expected source(s) of payment is coded on the medical
record, ask for a copy of the code definitions so that you can
properly complete this item.
If there are uncertainties about codes or payment plans, contact the
applicable hospital personnel for questions concerning sources of
payments.
The following are specific instructions for the various payment
sources. Mark as follows.
Box 1, Worker’s compensation–if the expected source of payment
is a state or municipal disability insurance or industrial accident
insurance. Do not include company health insurance plans or
direct payment by an employer in this category.

HDS-101

January 2004

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

Box 2, Medicare – if the payment is expected to be made under the
Health Care Financing Administration’s health insurance program
for the aged and disabled. This includes Medicare Part A and/or B
and patients under the renal dialysis program.
Box 3, Medicaid – if the payment is expected to be made under
Title XIX of the Social Security Act which gives Federal
assistance to states to provide health care, either secondary when a
patient has Medicare, or as a supplement for certain categories of
medically indigent patients. Medicaid may also be known as
public aid, medical assistance, general relief, or some title specific
to the state of residence, such as “Medi-Cal’ in California.
Box 4, Other government payments – if payment cannot be
classified in one of the other categories above (Boxes 1, 2 or 3).
This includes payments under the Title V Program, payments made
under the state funded Maternal and Child Health Program, state
funded Crippled Children’s Program, payments under CHAMPUS
(Civilian Health and Medical Program of the Uniformed Services)
or TRICARE (the Defense Department’s healthcare program for
service families), casualty insurance paid by the state, vocational
rehabilitation, Federal or state research grant (medical research), or
legal hold (prisoner in medical detention).
Box 5, Blue Cross/Blue Shield – if payment is expected by a Blue
Cross insurance plan, Blue Cross Association, or Blue Shield
plans. Do not mark Blue Cross for Medicare programs administered by Blue Cross unless the hospital lists this as Blue Cross.
Box 6, HMO/PPO – if payment is to be made by any Health
Maintenance Organization or Preferred Provider Organization
sponsored by consumers, communities, physicians, or hospitals.
Box 7, Other private or commercial insurance – if the payment is
by any private insurance plan not specified in 5 or 6 above. This
category includes medical coverage provided by life insurance
companies, casualty insurance companies, health insurance
companies, and independent plans such as employer/union
sponsored plans and/or self-funded plans (partial or total).
35

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section C,
Administrative Info,
Continued

Box 8, Self pay – if a major share of the total costs for this
hospitalization is expected by the patient, spouse, family, or next
of kin.
Box 9, No charge – for patients admitted with the understanding
that payment would not be expected because the medical services
are free. This category includes hospital-sponsored welfare, staff
services donated, hospital-sponsored special research or ‘teaching’
patients. Do not include patients who, following their
hospitalization, failed to pay their bill. For such patients, there was
an expected source of payment at the time of admission and the
appropriate category should be marked.
Box 10, Other – to include any nonprofit source of payment such
as church welfare, United Way (United Appeal), or Shriner’s
Crippled Children Services. Specify in the space provided on the
HDS-1 the exact expected source of payment.
No Source of Payment indicated – for patients whose expected
source(s) of payment is not indicated.

Completing Section D,
Medical Information

Item 17, Admitting Diagnosis:
The inpatient admitting diagnosis may be expressed as one of the
following:
• One or more significant findings (symptoms or signs)
representing patient distress or abnormal findings on
examination.
•

A “possible” diagnosis based on significant findings
(working diagnosis).

•

A diagnosis established on an ambulatory care basis or on
previous hospital admission.
36

HDS-101

January 2004

Topic 4. Completing the HDS-1, Continued
Completing Section D,
Admitting Diagnosis,
Continued

•

An injury or poisoning.

•

A reason or condition not classifiable as an illness or
injury, such as pregnancy in labor, follow-up examination,
and so forth.

Report only one admitting diagnosis and enter in the description
space.
If your hospital uses the ICD-9-CM coding classification, also
enter the ICD-9-CM code in the code entry space.
Expect the admitting diagnosis to vary from that of the principal
diagnosis at time of discharge.

Item 18, Final Diagnoses:
The principal diagnosis is the condition established after study to
be chiefly responsible for the patient’s admission to the hospital.
If a principal diagnosis is specified, enter the physician’s exact
terminology in the third column, “Description,” on the Principal
diagnosis line. If a principal diagnosis is not specified, enter the
first-listed diagnosis as principal.
Enter all other/additional final diagnoses shown (up to seven final
diagnoses) except the one you wrote next to ‘principal.’
Enter all E-Code diagnoses (external causes of injury and
poisoning) specified in the medical record as other/additional.

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section D,
Medical Information,
Continued

Include as Final Diagnoses:

Exclude:

Discharge diagnoses
Primary diagnoses
Final diagnoses
Secondary diagnoses
Associated diagnoses
Additional diagnoses
Other diagnoses
Complications
E-Codes
V-Codes

Admitting diagnoses
Provisional diagnoses
Tentative diagnoses
Working diagnoses

If your hospital uses the ICD-9-CM coding classification, enter these
codes and the narrative (if available) in the appropriate diagnosis spaces.
For each final diagnosis listed, mark the appropriate “Present on
Admission (POA)” category. Obtain this information from the face
sheet of the medical record.
Mark box 1, “Yes” if information on the face sheet explicitly states that
the diagnosis was present on admission.
Mark box 2, “No” if information on the face sheet explicitly states that
the diagnosis was not present on admission.
Mark box 3, “Unknown” if the information on the face sheet is unclear
as to whether a diagnosis was present on admission.
Mark box 4, “Clinically undetermined” if the information on the face
sheet indicates that it cannot be determined whether or not the diagnosis
was present on admission.
Mark box 5, “No information on face sheet” if there is no information at
all on the face sheet as to whether a diagnosis was present on admission.
Note: If the face sheet explicitly states that the diagnosis is exempt from
present on admission (POA) reporting, then mark box 2, “No.”
38

HDS-101

January 2007

Topic 4. Completing the HDS-1, Continued
Completing Section D,
Medical Information,
Continued
Item 19, Surgical and Diagnostic Procedures:
Report all procedures in operating rooms, those that carry an operative
or anesthetic risk, that require highly trained personnel, special facilities,
or equipment.
The principal procedure is the one most related to the principal diagnosis
and performed for definite treatment. If specified, enter the physician’s
exact terminology in the third column, “Description,” on the Principal
procedure line. If a principal procedure is not stated, record the first
shown as the principal procedure.
List all other procedures shown (up to four total procedures) except the
one listed as principal. Try to list only one procedure on each line so
that it can be associated with the appropriate date.
If your hospital uses the ICD-9-CM coding classification, enter these
codes and the narrative (if available) in the appropriate procedure
spaces.
Date of Procedure: Record the date of procedure in the boxes to the right
of each appropriate procedure. Use two-digit numbers for the month
and day and four digits for the year. Example:
For April 1, 2007, enter ‘04-01-2007’ in the appropriate boxes.
Final Steps

If you have any comments to provide about the sample discharge, enter
brief remarks in the Comments space.
Enter your name and the date you complete each Medical Abstract at the
bottom of the form.
Review each completed HDS-1 for omissions or inconsistencies. Make
any necessary corrections before mailing to the regional office.

HDS-101

January 2007

Topic 5. Submitting Completed Abstracts
When to Submit Abstracts

Send completed abstracts to the regional office on a flow basis but
there should not be a lag of more than 3 months in abstracting.
It is the end of September. At a minimum,
abstracting of January through June discharges
should be completed.

Example:

Schedule For Completing Medical Abstracts
Abstracts For:

Complete No Later Than:

January
February
March
April
May
June
July
August
September
October
November
December

April
May
June
July
August
September
October
November
December
January
February
March

HDS-101

January 2007

Chapter 4
Transmitting Data and Correspondence
Topic
1.

See Page

Completing the Transmittal
Form

Mailing the NHDS
Materials/Correspondence

HDS-101

January 2007

Topic 1. Completing the Transmittal Form
Introduction

After completing and verifying the medical abstracts, prepare a Form
HDS-3, Transmittal Notice (see Appendix E). The Transmittal Form
shows what is included with your shipments to the regional office,
including other administrative information.
The HDS-3 is a four-part form on NCR (no carbon required) paper. The
top copy (white) will contain medical record numbers and possibly other
personal identifying information which will not appear on the other
copies. To assure patient confidentiality, the top copy will be retained
by the hospital.
Note: Do not hold any month(s) of work for missing records since they
may be transmitted as ‘back records’ with a later shipment.

Completing the HDS-3

Item 1 – Record the date the transmittal is completed.
Item 2 – Record the number preassigned by NCHS which identifies
your hospital (see the inside front cover of the manual).
Item 3 – Enter the Regional Office name where you will be mailing the
materials (see the inside front cover of the manual).
Item 4 – Enter the hospital’s name and mailing address.
Item 5 – enter the following:
a.

Record the month and year of the data being transmitted and enter
the number of abstracts being transmitted.

Record the number of back records, that is, abstracts which were
not available for a previous shipment but are now available for this
shipment.

Record the total number of records being transmitted.

HDS-101

January 2007

Topic 1. Completing the Transmittal Form, Continued
Completing the HDS-3,
Continued
Item 6 – If applicable, list the HDS number and the medical record
number for each ‘back record’ that is included in the transmittal. Note:
The number of back records here should equal the entry in 5b.
Note: The Medical Record Number is for the hospital’s use only.
These numbers are blackened out on copies submitted to the Census
Bureau and the NCHS.
Item 7 – If applicable for the data month being transmitted, list the HDS
number and the medical record number for each record that was not
available for abstracting at this time. As indicated in Item 6, the medical
record numbers will not be submitted to the Census Bureau and the
NCHS.
Item 8 – Mark the appropriate box. If ‘yes’, record the name and title of
the new abstractor.
Item 9 – Mark the ‘Abstracted by hospital personnel’ box.
Item 10 – Request supplies by entering the number of each form needed.

HDS-101

January 2007

Topic 2. Mailing the NHDS Materials and Correspondence

Mailing the Materials

Use the 2nd Day FedEx preaddressed envelopes in your supplies and
mail the NHDS materials to the Census Bureau Regional Office.
Include the following in each shipment:
$
$
$

Questions

Three copies of the HDS-3 (keep the white copy for your files)
Three copies of the HDS-5 (keep the white copy for your files)
Completed abstracts

For questions about the survey, feel free to call the Census Regional
Office during normal business hours or contact them via E-mail. The
telephone number(s) and E-mail address are listed on the inside front
cover of this manual.

HDS-101

January 2007

Chapter 5
Providing NHDS Data by Computer Printouts

Topic

See Page

1. Providing Printout Data

2. Printout Specifications –
Sampling and Statistical Data

3. Printout Specifications –
Abstracting

4. Mailing Printout Materials

HDS-101

January 2007

Topic 1. Providing Printout Data
Introduction

With the approval of the National Center for Health Statistics (NCHS),
hospitals may supply the NHDS data on computer-generated printouts.
NCHS prefers that the data items on the printout follow the same
sequence as they appear on Form HDS-1, Medical Abstract; however,
this is not necessarily essential to receiving printout approval.
While NCHS staff allow as much latitude as possible in determining
acceptable formats for printouts, some are found to be unacceptable due
to the amount of effort required for NCHS to key and code the data.
Therefore, hospital staff should provide an example of their proposed
format to NCHS for approval prior to submitting the first month’s
NHDS data. Your Census Bureau contact listed on the inside cover of
this manual will provide assistance in receiving NCHS approval.
Samples of the variety of acceptable printouts are presented in
Appendices F1 – F2.
A Code Sheet providing item translations will need to be submitted to
NCHS along with the proposed printout format if:
(1)

The codes which will be used on the printout are different than
those recommended for each variable presented in Topic 3 of this
chapter, and/or

(2)

The categories within some of the variables are different than those
requested.

An example of one of these code sheets is presented in Appendix G.
The topics in the succeeding pages outline the various procedures for
sampling, abstracting, and transmitting computer printout data for the
National Hospital Discharge Survey.

HDS-101

January 2004

Topic 2. Printout Specifications - Sampling and Statistical Data
Sampling

The NHDS collects data on a sample of patient discharges every
month. All inpatients discharged during the month are eligible for
that month’s sample. This includes:
•

People admitted, assigned a bed, then discharged later that
day or at a later date, either with or without approval;

Newborn infants born alive;

Inpatients discharged because of death;

Inpatients discharged or transferred to another short-term
hospital, or to a long-term institution, such as a nursing
home;

Patients discharged and transferred to another unit within
the hospital, such as a nursing home unit, psychiatric unit,
and so on.

Persons who are ineligible (out-of-scope) for the NHDS
should not be included for sampling purposes. These
include:

Persons dead on arrival (DOA);

Fetal deaths or stillbirths;

Patients who die in the emergency room or in the operating
room without having been admitted either before or after
death;

Patients given a pass to leave the hospital for a short period
of time but not actually discharged from the hospital;

Patients transferred from one service or room to another but
not actually discharged from the unit or hospital;

Outpatients;

Same day surgery/ambulatory surgery patients.
47

HDS-101

January 2007

Topic 2. Printout Specifications for Sampling and Statistical Data, Continued
Sampling, Continued

To select the sample of records for each month’s discharges, apply
the sample key number(s) shown on the inside front cover of this
manual to the last digit(s) of the patient’s medical record number
or other patient identification number.
Example:

Statistical Data

If the sample key number is ‘02’, select records
whose numbers end in 02, such as 434402, 434602,
435002A, and so on. Disregard any alphabetical
suffixes or prefixes.

The NHDS needs a few statistical data items for each sampled
month. Use Form HDS-5, Sample Listing Sheet, to list the
statistical data for each sampled month. Prepare a separate HDS-5
for each month sampled. Complete only the items listed below.
See Appendix H for an example.
$

Hospital name (A.1)

Hospital Number (A.2): The NHDS identification number
for your hospital as shown on the inside front cover of this
manual.

Total Beds (B.1): The number of inpatient beds in the
hospital on the last day of the month for which the sample
is selected. Exclude bassinets for newborn infants and beds
used only for emergency service or by the staff. A bed is
any bed, crib, or pediatric bassinet set up and regularly
maintained for use by inpatients, not including bassinets
available for newborns.

Live births (B.3): The total number of live births delivered
at the hospital during the sample month. If none, enter ‘0.’

Total discharges (B.4): The total number of inpatient
discharges for the month, including deaths and newborn
infants.

HDS-101

January 2004

Topic 2. Printout Specifications for Sampling and Statistical Data, Continued
Statistical Data,
Continued

•
•

Data month (C.1): The month for which the sample is
selected.
Data year (C.1): The year for which sample is selected

• Number in sample C.3): The total number of sampled cases
for the month.

HDS-101

January 2007

Topic 3. Printout Specifications - Abstracting
Abstracting

The NHDS collects certain information on the patient and hospital
stay for each sampled case. As discussed in Topic 1 of this
chapter, NCHS prefers that hospitals submit printouts in the same
format as the HDS-1, Medical Abstract (see Appendix B), but will
accept other comparable formats (see Appendices F1 - F3).
Begin with the January data month and print the data items listed
below for each record. Please do not mix different data months
together. If the codes stated in the instructions throughout this
section are different for your hospital, please provide the
appropriate coding sheet(s) and a description of each item printed
to the NCHS.

NHDS Data Items

Hospital Number: This number which has been assigned to
your hospital by NCHS is on the inside front cover of this manual.

HDS Number: Assign a consecutive 4-digit number for each
case, beginning with ‘0001.’ Continue numbering for the entire
data year. In January of the following year, start again with
‘0001’. If the computer cannot generate the HDS numbers, please
enter these numbers by hand to the left of each case.

Date of Admission: Print out the date the patient was admitted
for the particular hospital stay. Use 2-digit numbers for the month
and day and 4-digit numbers for the year. The recommended
format is “MM-DD-YYYY”.
For newborn infants, the date of birth is the date of admission.

HDS-101

January 2004

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Continued

Date of Discharge: Print out the date the patient was discharged
from the hospital for the particular stay. Use 2-digit numbers for
the month and day and 4-digit numbers for the year. The
recommended format is “MM-DD-YYYY”.
Note: If the date of admission and discharge are the same,
please ensure that outpatients are not included as sampled
cases. As discussed in Topic 2 of this chapter, outpatients are
out-of-scope for the survey.

Residence ZIP Code: Print out the 5-digit ZIP code for the
patient’s residence. If not indicated, leave this data field blank.

Date of Birth: Print out the patient’s date of birth, using 2-digit
numbers for the month and day, and 4-digit numbers for the year.
The recommended format is “MM-DD-YYYY.”
If the date of birth is not available, print out the patient’s age,
allowing for three characters.

Sex: Print out the appropriate sex of the patient. The
recommended codes are:
M or 1= Male

F or 2 = Female

U or 3 = Not Stated

HDS-101

January 2007

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Continued

Ethnicity: This refers to the national or cultural group from
which a person is descended, and is determined by the nationality
or lineage of a parent, grandparent or other ancestors. Ethnicity is
not necessarily related to one’s race. Consider race and ethnicity
as two independent characteristics. Do not base a person’s ethnic
background on the name or the birthplace.
Print out the appropriate ethnicity of the patient:
H, L or 1 =

Hispanic or Latino if the patient is of Cuban,
Mexican, Puerto Rican, South or Central American,
or other Spanish culture or origin, regardless of
race. The term, “Spanish Origin” can be used in
addition to “Hispanic or Latino.”

N or 2 =

Not Hispanic or Latino if the patient’s descent is
other than Hispanic or Latino.

U or 3 =

Not stated if the patient’s ethnicity is not indicated.

Race: Print out the appropriate race of the patient. If there are
two or more races, print out all appropriate codes:
W or 1 =

White if the patient is white, Caucasian or has
origins in any of the original peoples of Europe, the
Middle East or North Africa.

B or 2 =

Black or African American if the patient has origins
in any of the black racial groups of Africa. Terms
such as ‘Haitian’ or ‘Negro’ can be used in addition
to ‘Black or African American.’

I or 3 =

American Indian or Alaska Native if the patient has
origins in any of the original peoples of North and
South America (including Central America), and
who maintains tribal affiliation or community
attachment.

HDS-101

January 2004

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items-Race, Continued

A or 4 =

Asian if a patient has origins in any of the original
peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, Philippine Islands, Thailand, and
Vietnam.

N or 5 =

Native Hawaiian or Other Pacific Islander if the
patient has origins in any of the original people of
Hawaii, Guam, Samoa, or other Pacific Islands.

O or 6 =

Other or Not Stated if the patient’s race does not fall
into a category described above.

U or 7 =

Not stated if the patient’s race is not indicated or if
the race is marked ‘Hispanic” and no other racial
information is provided. Also code ‘not stated’ if
“Asian/Pacific Islander’ is specified.

Marital Status: Print out the marital status of the patient. For
newborns, always indicated ‘single’.
M or 1 = Married
S or 2 = Single
W or 3 = Widowed

D or 4 = Divorced
X or 5 = Separated
U or 6 = Not Stated

Type of Admission: Print out the admission type as follows:
1 = Emergency if the patient required immediate medical
intervention as a result of severe life threatening or potentially
disabling conditions. Patient generally is admitted through the
Emergency Room.
2 = Urgent if the patient required immediate care and treatment of
a physical or mental disorder. Patient generally is admitted to the
first available and suitable accommodation.
3 = Elective if patient’s condition permitted adequate time to
schedule the availability of a suitable accommodation.
53

HDS-101

January 2007

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Type of Admission,
Continued

4 = Newborn if the baby was born within the facility.
5 = Item not available if the admission type for the patient is not
available.

Source of Admission: Print out the admission source as
follows:
1 = Physician referral if the patient was admitted to this facility
upon the recommendation of his/her personal physician.
2 = Clinical referral if the patient was admitted to this facility upon
recommendation of the facility’s clinic physician.
3 = HMO Referral if the patient was admitted to this facility upon
the recommendation of a health maintenance organization
physician.
4 = Transfer from a hospital if the patient was admitted to this
facility as a transfer from an acute care facility where he/she was
an inpatient.
5 = Transfer from SNF if the patient was admitted to this facility as
a transfer from a skilled nursing facility where he/she was an
inpatient.
6 = Transfer from other health facility if the patient was admitted
to this facility as a transfer from a health care facility other than an
acute care facility or a skilled nursing facility. This includes
transfers from nursing homes, long-term care facilities, and SNF
patients who are at a non-skilled level of care.
7 = Emergency Room if the patient was admitted to this facility
upon the recommendation of this facility’s emergency room
physician.

HDS-101

January 2004

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Admission Source,
Continued

8 = Court/Law Enforcement if the patient was admitted to this
facility upon the direction of a court of law, or upon the request of
a law enforcement agency representative.
9 = Other if the patient was admitted to this facility for a reason
other than those categorized above, for example: newborn,
transfer from a Rural Primary Care Hospital, etc.
10 = Item not available if the information for the source of
admission is not available.

Status/Disposition of patient: Print as appropriate for the patient;
the recommended codes are listed below.
1a = Routine discharge/discharged home for patients who were
discharged to return home. Include all patients referred to
home health care services, specialty clinics, family physician,
home health care IV provider, or discharged to a relative,
foster home, or transferred to a corrections institute.
1b = Left against medical advice for patients who refused further
medical care and left the hospital regardless of whether a
release of responsibility statement was signed or not. Also,
include those patients who left without informing any
members of the medical staff.
1c = Discharged, transferred to another short-term hospital for all
patients who were transferred to another short-term hospital.
Include all short-term maternity hospitals.

HDS-101

January 2007

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items, Status/
Disposition Continued
1d = Discharged, transferred to long-term care institution for all
patients who were transferred or returned to a nursing home,
skilled nursing facility (SNF), an extended care facility, an
intermediate care facility (ICF), or a custodial care facility.
1e = Other disposition/not stated if the discharge status of the
patient is ‘alive’ and the disposition of the patient is unknown
or patient is transferred to other facility and the type of
facility cannot be classified as short-term or long-term.
Include in this category patients transferred to state facility,
psychiatric facility, terminal care/hospice facility,
rehabilitation facility and specialty hospital.
2 = Died for patients who died after being admitted to the
hospital.
3 = Discharge status and disposition is not indicated.
Expected source(s) of payment: Print the principal source first,
followed by any additional expected sources of payment.
1 = Worker’s compensation if the expected source of payment is
a state or municipal disability insurance or industrial accident
insurance. Do not include company health insurance plans or
direct payment by an employer in this category.
2 = Medicare if the payment is expected to be made under the
Health Care Financing Administration’s health insurance program
for the aged and disabled. This includes Medicare Part A and/or B
and patients under the renal dialysis program.

HDS-101

January 2004

Topic 3. Printout Specifications -Abstracting, Continued
NHDS Data Items,
Expected Source(s) of
Payment, Continued

3 = Medicaid if the payment is expected to be made under Title
XIX of the Social Security Act which gives Federal assistance to
states to provide health care, either secondary when a patient has
Medicare, or as a supplement for certain categories of medically
indigent patients. Medicaid may also be known as public aid,
medical assistance, general relief, or some title specific to the state
of residence, such as “Medi-Cal’ in California.
4 = Other government payments if payment cannot be classified in
one of the other categories above (1, 2 or 3). This includes
payments under the Title V Program, payments made under the
state funded Maternal and Child Health Program, state funded
Crippled Children’s Program, payments under CHAMPUS
(Civilian Health and Medical Program of the Uniformed Services),
casualty insurance paid by the state, vocational rehabilitation,
Federal or state research grant (medical research), or legal hold
(prisoner in medical detention).
5 = Blue Cross/Blue Shield if payment is expected by a Blue Cross
insurance plan, Blue Cross Association, or Blue Shield plans. Do
not mark Blue Cross for Medicare programs administered by Blue
Cross unless the hospital lists this as Blue Cross.
6 = HMO/PPO if payment is to be made by any Health
Maintenance Organization or Preferred Provider Organization
sponsored by consumers, communities, physicians, or hospitals.
7 = Other private or commercial insurance if the payment is by any
private insurance plan not specified in 5 or 6 above. This category
includes medical coverage provided by life insurance companies,
casualty insurance companies, health insurance companies, and
independent plans such as employer/union sponsored plans and/or
self-funded plans (partial or total).

HDS-101

January 2007

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Expected Source(s) of
Payment, Continued

8 = Self pay if a major share of the total costs for this
hospitalization is expected by the patient, spouse, family, or next
of kin. If there are two or more sources of payment, ‘self-pay’
cannot be the principal source.
9 = No charge for patients admitted with the understanding that
payment would not be expected because the medical services are
free. This category includes hospital-sponsored welfare, staff
services donated, hospital-sponsored special research or ‘teaching’
patients. Do not include patients who, following their
hospitalization, failed to pay their bill. For such patients, there was
an expected source of payment at the time of admission and the
appropriate category should be marked.
10 = Other to include any nonprofit source of payment such as
church welfare, United Way (United Appeal), or Shriner’s
Crippled Children Services.
11 = No Source of Payment indicated for patients whose expected
source(s) of payment is not indicated.
Admitting Diagnosis: Print out the patient’s admitting diagnosis.
The admitting diagnosis may be expressed as one or more
significant findings (symptoms or signs) representing patient
distress or abnormal findings on examination; a possible diagnosis
based on significant findings (working diagnosis); a diagnosis
established on an ambulatory care basis or on previous hospital
admission; an injury or poisoning; or, a reason or condition not
classifiable as an illness or injury, such as pregnancy in labor,
follow-up examination, and so forth.
If your hospital uses the ICD-9-CM coding classification, print out
the code and the narrative (if available) for the admitting diagnosis.

HDS-101

January 2004

Topic 3. Printout Specifications - Abstracting, Continued
NHDS Data Items,
Continued
Final Diagnoses: Print out the patient’s principal diagnosis first,
then any other final diagnoses, up to seven total final diagnoses.
The principal diagnosis is the condition chiefly responsible for the
patient’s admission to the hospital for care.
Include E-Code (external causes of injury and poisoning)
diagnoses as ‘Other/Additional’ diagnoses.
If your hospital uses the ICD-9-CM coding classification, print out
these codes and the narrative (if available) for all final diagnoses.
Please do not zero fill any diagnosis data fields. If no diagnoses
are listed, enter “NA” once.
For each final diagnosis listed, print if the diagnosis was present on
admission (POA) as follows:
1 = Yes
2 = No
3 = Unknown
4 = Clinically undetermined

Surgical and Diagnostic Procedures: Print out the patient’s
principal procedure first, then list any other procedures, up to four
procedures. The principal procedure is the one most related to the
principal diagnosis and performed for definite treatment.
If your hospital uses the ICD-9-CM coding classification, print out
these codes and the narratives (if available).
Do not zero fill any procedure data fields. If there are no
procedures, enter “NA” once.

Date(s) of Procedure: Print out the date of each procedure, if
available, to the right of each listed procedure. The recommended
format is “MM-DD-YYYY”.
59

HDS-101

January 2007

Topic 4. Mailing Printout Materials
When to Mail

You may mail the NHDS printouts monthly, quarterly, semiannually, or annually. The NCHS asks hospitals to submit all
printouts no later than March 30th of the following year.

HDS-3, Transmittal

Include Form HDS-3, Transmittal, with the printout materials. The
HDS-3 shows what is included with your shipments to the regional
office, as well as other administrative information. An example of
a completed HDS-3 is shown on Appendix I.
Item 1 - Record the date the transmittal is prepared.
Item 2 - Record the number preassigned by NCHS which
identifies your hospital (see the inside front cover of the manual).
Item 3 - Enter the Regional Office name where you will be
mailing the materials (see the inside front cover of the manual).
Item 4 - Enter the hospital’s name and mailing address.
Item 5 - Enter the following:
a.

Record the month and year of the data being transmitted
and enter the number of records being transmitted.

Record the number of back records, that is, records which
were not available for a previous shipment but are now
available for this shipment.

Record the total number of records being transmitted.

Item 6 - Do not complete for printout submission.
Item 7 - Do not complete for printout submission
Item 8 - Mark the appropriate box. If ‘yes’, record the name and
title of the new MIS contact.
Item 9 - Mark the ‘Acceptable printout’ box.
Item 10 - Request supplies by entering the number of each form
needed.

HDS-101

January 2007

Topic 4. Mailing Printout Materials, Continued
Where and What to Mail

Questions

Use the 2nd Day FedEx preaddressed envelopes in your supplies
and mail the NHDS materials to the Census Bureau Regional
Office. Include the following in each shipment:
$

Three copies of the HDS-3 (keep the white copy for your
files),

Three copies of the HDS-5 (keep the white copy for your
files),

Completed printouts, and

Coding sheet(s) whenever the categories within a variable
have changed and/or a new variable has been added.

For questions about the printouts or the survey, feel free to call the
Census Regional Office during normal business hours or contact
them via E-mail. The toll free number and E-mail address are
listed on the inside front cover of this manual.

HDS-101

January 2007

NOTES

HDS-101

January 2007

Chapter 6
Providing NHDS Data in Machine Readable Form

Topic

See Page

1. Options for Providing
Machine Readable Data

2. The Sample and Data
Collection Periods

3. Labeling and Delivery of
Machine Readable
NHDS Data

HDS-101

January 2007

Topic 1. Options for Providing Machine Readable Data
Introduction

Hospitals may supply machine readable survey data for the National
Hospital Discharge Survey (NHDS) by producing a reel tape, cartridge
tape, CD-ROM, 3 ½" disk or by E-mail transmission. The machine
readable information transmitted to NCHS should consist of one of the
following:
•

Case-mix patient data reformatted and recoded to conform
precisely to the NHDS coding structure. The file layout is shown
in Appendix J.

•

UB-92 data elements which are used for billing purposes
reformatted to NHDS field length specifications. If a hospital
elects this option, only bills for inpatient acute care hospital
discharges are valid. All UB-92 billing codes (field 4 on UB-92
bill) which fall into the range 111-114 are acceptable. Hospitals
are expected to remove all other bill types from the data submitted
for the NHDS.
For hospitals that participate in Medicare’s tape-to-tape billing
program, all data needed by NHDS is accessible from the
following batch record numbers: 10 (Provider), 20 (Patient), 20
(Third Party Payor), and 70 (Medical). The hospital must
consolidate all necessary data elements from these 4 record types
to create a complete NHDS record for each bill.
If your hospital uses a UB-92 coding or modified structure it will
be necessary to send information about how each data element is
defined. With the first data submission, hospitals should submit a
document explaining the internal hospital codes used for each
specific data item.

HDS-101

January 2007

Topic 2. The Sample and Data Collection Periods
The Sample

The NHDS collects data on a sample of patient discharges every
month. Hospitals which transmit machine readable NHDS data
may choose to sample their discharges prior to transmission of the
file to the National Center for Health Statistics.
To select the sample of discharges, apply the sample key
number(s) shown on the inside front cover of this manual to the
last digit(s) of the patient’s medical record number or other patient
identification number (disregard any alphabetical suffixes). If the
hospital would prefer, a complete file of calendar year discharges
may be transmitted to NCHS for sampling.
Note: Medical Record Numbers or other patient identification
numbers are for use in sampling only and are not released to
the Census Bureau or the NCHS.

Data Collection Periods

Data for the NHDS are collected for the calendar year (patients
discharged January 1 - December 31). The NCHS normally
collects machine readable NHDS data from each hospital on an
annual basis. There are some hospitals, however, which transmit
data quarterly or semi-annually.
The deadline for submission of NHDS data is approximately 120
days after the end of the calendar year. When a hospital chooses to
submit machine readable data for the NHDS, the hospital contact is
notified by E-mail well in advance of the deadline. In the event
that a deadline cannot be met, NCHS will allow as much latitude
as possible.

HDS-101

January 2007

Topic 3. Labeling and Delivery of Machine Readable NHDS Data
Preparing the data for
Transmission To NCHS

Before sending a Reel Tape or Cartridge Tape to NCHS, please
keep a copy of each tape for a period of 60 days after mailing.
This will guard against the possibility of added delays in NHDS
processing due to tape loss, defective tapes, or inadvertent damage
during tape processing.
A printout of the first ten (10) records should be included with
each tape submitted to enable NCHS staff to review recoding and
reformatting specifications.
Each Reel Tape, Cartridge Tape, CD-ROM, 3 ½" Disk or E-mail
sent to NCHS should be accompanied by a clear description of the
layout and contents as well as a completed Transmittal Notice (see
Appendix K).

Completing the
Transmittal Notice

Complete the Data Source information on the HDS-3A Transmittal
Notice by providing:
$

Hospital name and number as shown on the inside front
cover of this manual,

Name of the person responsible for preparing the Reel
Tape, Cartridge Tape, CD-ROM, 3 ½" Disk or E-mail for
this project, and

Phone/Fax number where he/she can be reached if
questions arise concerning the data submitted.

HDS-101

January 2007

Topic 3. Labeling and Delivery of Machine Readable NHDS Data, Continued
Completing the
Transmittal Notice,
Continued

Physical standards for all data sent should be clearly stated on the
Transmittal Notice. Enter the information or mark the box as
appropriate for these items:
A.

File Name

Media: Reel Tape/Cartridge Tape/CD-ROM/3 ½" Disk/
E-Mail

Record Length: 135 characters

Data Structure: EBCDIC or ASCII

Block Size (Tapes)

Internal Label: Standard IBM label/No label (Tapes)

Data Set Name; Vol=Ser=

In the next section, enter the internal characteristics of the data:
A. Period Covered
B. Type of data: Mark either All discharges or Sampled
discharges
If you are submitting ‘Sampled discharges’, enter in Statistical
Also include an invoice with each submission, specifying:
•
•
•
•
•
•
•
•

Payee name and address
Employee Identification Number (EIN)
Reporting period for data submission
Total Number of records submitted
Shipping/Handling Cost
Tape Cost
Cost per record for machine readable data
Initial programming fee for conversion of hospital
coding structure and format to NHDS specifications (if
applicable)
67

HDS-101

January 2007

Topic 3. Labeling and Delivery of Machine Readable NHDS Data, Continued

Completing the Transmittal
Notice, Continued

The formula for payment of machine readable data submitted
for the NHDS is:
A. Unsampled Records - $0.02 per discharge record.
B. Sampled Records - Hospitals will be paid on a per sample
record basis according to the amount negotiated and recorded
on the Memorandum of Agreement (HDS-6225).
Send all data, documentation, invoices and correspondence
to:
Carol DeFances
National Center for Health Statistics
3311 Toledo Road, Room 3230
Hyattsville, MD 20782
E-Mail Address: [email protected]

File Type	application/pdf
File Title	hds-101.FH10
Author	chen0307
File Modified	2008-07-15
File Created	2007-11-01