Non-PRA applicable - EIP Facility Assessment

AttachmentJ_FINAL_0920-0852_2014EIPHFA_20140718.pdf

Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

Non-PRA applicable - EIP Facility Assessment

OMB: 0920-0852

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HAI & ANTIMICROBIAL USE PREVALENCE SURVEY
EIP HEALTHCARE FACILITY ASSESSMENT—FOR EIPT USE ONLY

Hospital ID: ________________________

1) Enter the date on which you are completing this form:

/

Survey date:

/

/

/

2) Enter your initials: _________
3) Is the hospital located in an urban or rural area?
☐Rural
☐Urban
☐Unknown
4) Does the hospital have an American Medical Association (AMA)-approved residency program?
☐Yes
☐No
☐Unknown
5) Is the hospital a member of the Council of Teaching Hospitals (COTH)?
☐Yes
☐No
☐Unknown


File Typeapplication/pdf
AuthorShelley Magill
File Modified2014-07-18
File Created2014-07-18

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