Att K - Pulling and Refiling Patient Record Forms

Attachment L: Pulling and Re-filing Patient Record Forms

Assurance of confidentiality-All information which would permit identification of an individual, a practice, or an establishment will be held confidential; will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls; and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Notice – Public reporting burden for this collection of information is estimated to average 1 minute per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Any agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0234).

Based on 2006 data, we estimate that approximately 893 physicians/CHC providers will participate in NAMCS, but will ask Census abstractors to complete the Patient Record forms. The average burden for these special study/pretest respondents is one minute for each form, which includes simply pulling and re-filing the medical records. Each office submits forms on about thirty patients, which makes the total burden for each office approximately thirty minutes.