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57.139 MDRO and CDI Monthly Monitoring for LTCF
ICR 201211-0920-005 · OMB 0920-0666 · Object 35877501.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | 57.139 MDRO and CDI Monthly Monitoring for LTCF |
| Author | Amy Schneider |
| Last Modified By | Writer |
| File Modified | 2012-10-10 |
| File Created | 2026-10-10 |
| Conversion State | complete |
Extracted Text
MDRO and CDI Monthly Monitoring for LTCF Page 1 of 1 *required for saving **conditionally required based upon monitoring selection in Monthly Reporting Plan Facility ID #: ______________ *Month: _____________ *Year: __________ *Location Code: ____________ **Resident Days: ________________ **Resident Admissions: ___________________ LabID Event Reporting Specific Organism Type MRSA VRE CephR-Klebsiella CRE- E. coli CRE-Klebsiella MDR-Acinetobacter C.difficile LabID Event (All specimens) □ □ □ □ □ □ □ Custom Fields Label _____________ _____________ _____________ _____________ _____________ Data _____________ _____________ _____________ _____________ _____________ Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)). Public reporting burden of this collection of information is estimated to average 5 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, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666). CDC 57.139 v.7.0