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For
each therapeutic listed, enter number of residents who received
were
administered
the therapeutic at this facility or elsewhere during the
reporting week:
Therapeutic:
Bamlanivimab
(Lilly)
How
many residents were treated from stock stored at this facility?
**How
many residents were treated from stock that was stored at another
facility, such as an infusion center?
Therapeutic:
Casirivimab
plus Imdevimab (Regeneron)
How
many residents were treated from stock stored at this facility?
**How
many residents were treated from stock that was stored at another
facility such as an infusion center?
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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)).
CDC
estimates the average public reporting burden for this collection
of information as 10 minutes per response, including the time for
reviewing instructions, searching existing data/information
sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road
NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX). CDC
57.XXX
(Front) January 2021, V1
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