Form 0920-19AYV Monthly Data Report Form Candida

Public Health Laboratory Testing for Emerging Antibiotic Resistance and Fungal Threats

Attachment 3f Form 6 Monthly Data Report Form_Candida identification final

Monthly Data Report Form Candida

OMB: 0920-1310

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Form Approved

OMB Control No.: 0920-XXXX

Expiration date: XX/XX/XXXX


Monthly Data Report Form – Candida identification

Data element Name

Data element Definition

Yourlab_state

State or jurisdiction of the AR Lab Network lab submitting this data

Reporting_month

This is the year and month this report is counted for CDC reporting; it is based on the date of collection.

Reported_to_submitter_date

Date reported to the submitter (clinical lab or healthcare facility of origin) by the jurisdictional PHL

Granularity = day

Patient_ID

1) Unique patient ID assigned by the public health

department.

2) Unique patient ID assigned by the hospital/facility.

3) Other unique patient ID.

The patient ID should facilitate linking lab data to data

provided from epidemiologists and other sources in public health.

Patient_age

Age at specimen collection date

Patient_age_unit

Could be years, months, days

Patient_sex

Patient sex

Patient_race

Patient race

Patient_ethnicity

Patient ethnicity

Patient_county

County of residence

Patient_county_code

County code of residence

Patient_state

State of residence

Patient_country

Country of residence

ARLN_PHL_sent

The coded representation of the ARLN regional lab where the isolate was sent (if it was sent)

Processing_Laboratory_ID

ID for the processing laboratory

Processing_laboratory_name

The lab that isolates the organism or that collects and processes clinical specimens (when not the healthcare facility of origin). This can be a public health lab or clinical lab.

FacilityID

ID of the healthcare facility of origin (i.e., where patient was located when testing was initiated)

FacilityName

Where the patient was located when testing was initiated.

FacilityState

State of the healthcare facility of origin

Submitter_facility_ID

ID of the submitting facility

Submitter_facility_name

The name of the facility or clinical laboratory that collected and processed the specimen and sent it (and a request for testing) to the AR Lab Network lab, and to which the testing public health lab is reporting the results back to.


Submitter_facility_state

State of the submitting facility

Submitter_facility_zipcode

Zip code of the submitting facility

Specimen_collection_date

Date specimen collected

Specimen_received_date

Date specimen received for ARLN testing

Submitter_Specimen_ID

This is the Specimen ID assigned by the submitting entity (facility, laboratory, etc).

ARLN_Isolate_ID

The ARLN Isolate ID is the testing lab’s isolate ID

ARLN_Specimen_ID

The ARLN_Specimen_ID is the testing lab's specimen ID

Specimen_type

Specimen type

This is describing the clinical specimen.

Isolate_forwarded_to_RegLab

Identifies that the PHL has forwarded an isolate to an ARLN regional lab for additional testing.

Date_forwarded_to_RegLab

The date a PHL has forwarded an isolate to an ARLN regional lab for additional testing.


Granularity = day

Test_date

Date the test was performed

Species_identified_by_clinical_lab

Species identified at the clinical lab

Species_identified_by_yourlab

Species identified at the AR Lab Network lab

Yourlab_comment

Comments from the AR Lab Network lab

reporting_complete

Completion status

Organism_Suspected

Organism that is suspected, or intended to be ruled out, as recorded on the order



Public reporting burden of this collection of information is estimated to average 120 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorGilbert, Sarah (CDC/DDID/NCEZID/DHQP) (CTR)
File Modified0000-00-00
File Created2021-01-14

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