Attachment G: Example Screen Shots of ASC Survey on Patient Safety Culture Data Submission Website Information Collection

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Database, Supporting Statement B

Attachment G: Example Screen Shots of Ambulatory Surgery Center Survey on Patient Safety Culture Data Submission Web Site Information Collection

Figure 1: Submit Data Use Agreement (DUA) and Link DUA to Ambulatory Surgery Center(s)

Figure 1: Submit Data Use Agreement (DUA) and Link DUA to Ambulatory Surgery Center(s), continued

Figure 1: Submit Data Use Agreement (DUA) and Link DUA to Ambulatory Surgery Center(s), continued

Figure 2: Submit Questionnaire and Link Questionnaire to Ambulatory Surgery Center(s)

Figure 2: Submit Questionnaire and Link Questionnaire to Ambulatory Surgery Center(s), continued

Figure 2: Submit Questionnaire and Link Questionnaire to Ambulatory Surgery Center(s), continued

Figure 3: Upload Data for Each Participating Ambulatory Surgery Center

Figure 3: Upload Data for Each Participating Ambulatory Surgery Center (continued)

Figure 3: Upload Data for Each Participating Ambulatory Surgery Center (continued)