Form 1 Medical Record Data Abstraction Screenshots

Chart Abstraction of Ryan White HIV/AIDS Program Recipient Data

INSTRUMENT Medical Record Data Abstraction Screenshots

Medical Record Data Abstraction

OMB: 0906-0050

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1. Login Screen

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

2. Creation of de-identified eUCI number

3. Top Navigation

4. Footer Navigation

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

5. Client Information/ Demographics Screen

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

6. HIV Medical Visit Screen

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

7. Medications Screen

8. Lab Testing Screen

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

9. Vaccines Screen

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX

OMB No. 0906 – xxxx Expiration Date XX/XX/20XX


File Typeapplication/pdf
AuthorCicely Wanska
File Modified2019-10-21
File Created2019-09-12

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