Patient Medical Record and Clinic Data

Patient Navigator Outreach and Chronic Disease Prevention Demonstration Program

OMB: 0915-0346

IC ID: 198108

Information Collection (IC) Details

View Information Collection (IC)

Patient Medical Record and Clinic Data
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 8 Clinical Measures HRSA Patient Navigator Demonstration Program Clinical Measures Lab Tests.doc Yes Yes Fillable Printable
Form and Instruction 7 Co-occuring Disorders HRSA Patient Navigator Demonstration Program Co occurring Disorders.doc Yes Yes Fillable Fileable

Health Health Care Services

 

10 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,827 0 4,827 0 0 0
Annual IC Time Burden (Hours) 821 0 821 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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