Att E - 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

NOTICE: Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to: CDC/ATSDR Information Collection Review Office; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:
PRA (0920-0234).
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).
OMB No. 0920-0234: Approval expires 03/31/2013

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Skipping height through BP systolic screens- simply asks to fill in the number for: Height (Feet), Height
(Inches), Height (Centimeters), Weight (Pounds), Weight (Ounces), Weight (Kilograms), Weight (Grams).

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module

Attachment E: 2012 NAMCS Lookback Module