Document
LTC Ventilator Capacity
ICR 202005-0920-004 · OMB 0920-1290 · Object 100985001.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | LTC Ventilator Capacity |
| Author | Wattenmaker, Lauren (CDC/DDID/NCEZID/DHQP) |
| Last Modified By | Writer |
| File Modified | 2020-04-23 |
| File Created | 2026-09-20 |
| Conversion State | complete |
Extracted Text
COVID-19 Module Long Term Care Facility: Ventilator Capacity & Supplies NHSN Facility ID: CMS Certification Number (CCN): Facility Name: **Do you have a ventilator dependent unit in your facility? □ YES □ NO If, NO, Skip this form *Date for which responses are reported: ________/________/________ For the following questions, please collect data at the same time at least once a week (for example, 7 AM) *Required for saving **Form to be completed only if facility has ventilator dependent units