Download:
pdf |
pdfU.S. HEALTHCARE COVID-19 PORTAL OMB No. 0990-0478 Expires: 08/31/2024
Advanced Care Hospital Of Montana
Welcome, Scott Jubeck
HHS ID: -- CCN:272001 NPI:1356536312 AHA: 6810122 NHSN OrgID: 29662
Facility Type: Long Term Acute Care Hospital
3528 Gabel Rd
Billings, MT, 59102
CHANGE FACILITY VIEW
New Capacity & Utilization Entry For November 29, 2021
Entering Data For
DATA UPLOAD
SUBMIT
CANCEL
November 29, 2021
It is critical to the COVID-19 response that all of the information listed below is provided to the Federal Government on the requested reporting schedule to facilitate planning, monitoring, and resource allocation during the COVID-19 Public Health
Emergency (PHE). All fields are mandatory unless otherwise noted in the HHS Guidance.
Note: Provide data entries for all requested fields. Enter 0 or select N/A (if available) if the item is not applicable at your facility.
Note: Some data points in the web form are pre-populated with the most recent non-null submission. Please update each data point as necessary. Learn more about Composite Records.
Upload Data File:
Choose File No file chosen
If you do not have the template, please download it from here.
8 new fields have been added to the form as of 12/1/2021.
Some data elements have been made inactive for the federal data collection. These fields have been moved to a separate section labeled accordingly. Hospitals no longer need to report these data elements.
Note: State, local, tribal, and territorial (SLTT) partners may have reporting requirements related to or independent of the federal reporting requirements. Facilities are encouraged to work with relevant (SLTT) partners to ensure complete
reporting for all partners.
The following fields will be required weekly beginning 12/15/2021:
40c. Sotrovimab (Therapeutic D) Current Inventory on Hand (in courses)
40d. Sotrovimab (Therapeutic D) Courses used in the last week
The following fields will be required daily beginning 12/29/2021:
3c. All pediatric inpatient beds
4c. Pediatric inpatient bed occupancy
5c. Pediatric ICU beds
6c. Pediatric ICU bed occupancy
12c. Hospitalized ICU laboratory-confirmed COVID-19
18a. Total pediatric (Previous Day's admissions with confirmed COVID-19 and breakdown by age bracket)
33. Total hospitalized patients with laboratory-confirmed influenza virus infection
34. Previous day's admissions with laboratory-confirmed influenza virus infection
35. Total hospitalized ICU patients with laboratory-confirmed influenza virus infection
Staffed Bed Capacity
3a. All hospital inpatient beds
4a. All hospital inpatient bed occupancy
40
36
3b. Adult hospital inpatient beds
36
3c. All inpatient pediatric beds (Optional)
Unknown
6a. ICU bed occupancy
0
5b. Adult ICU beds
0
4c. Pediatric inpatient bed occupancy (Optional)
Unknown
0
4b. Adult hospital inpatient bed occupancy
40
5a. ICU beds
6b. Adult ICU bed occupancy
0
5c. Pediatric ICU beds (Optional)
Unknown
6c. Pediatric ICU bed occupancy (Optional)
Unknown
Hospitalizations
9a. Total hospitalized adult suspected or laboratoryconfirmed COVID-19 patients
10a. Total hospitalized pediatric suspected or laboratoryconfirmed COVID-19 patients
3
11. Hospitalized and ventilated COVID-19 patients
0
9b. Hospitalized adult laboratory-confirmed COVID-19
patients
0
10b. Hospitalized pediatric laboratory-confirmed COVID-19
patients
3
12a. Total ICU adult suspected or laboratory-confirmed
COVID-19 patients
0
12b. Hospitalized ICU adult laboratory-confirmed COVID-19
patients
0
0
12c. Hospitalized ICU pediatric laboratory-confirmed COVID19 patients (Optional)
Unknown
13. Hospital onset
0
Emergency Department
19. Previous day’s Emergency Department (ED) Visits
20. Previous day’s total COVID-19-related ED Visits
Unknown
Unknown
Previous Day's Admissions
Note: The age brackets under fields 17a and 17b are required to be considered compliant.
Previous Day's adult admissions with
laboratory-confirmed COVID-19 and
breakdown by age bracket:
17a. Total adult
Previous Day's adult admissions with
suspected COVID-19 and breakdown by age
bracket:
17b. Total adult
Unknown
Unknown
A value is required in this field for submission.
A value is required in this field for submission.
18-19
Previous Day's pediatric admissions with
laboratory-confirmed COVID-19 breakdown by
age bracket:
18a. Total pediatric
5-11 (Optional)
Unknown
30-39
Unknown
30-39
Unknown
12-17 (Optional)
Unknown
40-49
Unknown
40-49
Unknown
Unknown
Unknown
50-59
Unknown
Unknown
20-29
Unknown
18b. Total pediatric
0-4 (Optional)
Unknown
20-29
Unknown
18-19
Unknown
Previous Day's pediatric admissions with
suspected COVID-19:
0
50-59
Unknown
Unknown
60-69
60-69
Unknown
Unknown
70-79
70-79
Unknown
Unknown
80+
80+
Unknown
Unknown
Unknown
Unknown
0
0
Therapeutics
Note: For fields 39a - 40d below, report one time a week on Wednesday.
Casirivimab (REGN10933) / Imdevimab
(REGN10987) (Therapeutic A)
39a. Current inventory on hand (in courses)
0
39b. Courses used in the last week
Bamlanivimab and Etesevimab (Therapeutic C)
Sotrovimab (Therapeutic D)
40a. Current Inventory on hand (in courses)
40c. Current Inventory on hand (in courses) (Optional)
0
0
40b. Courses used in the last week
Unknown
0
40d. Courses used in the last week (Optional)
Unknown
Staff
Note: Field 24 will always default to “No” for a new submission.
24. Critical staffing shortage anticipated within a week (Y/N)
(Optional)
No
PPE
Note: For fields 27 - 30 below, report one time a week on Wednesday.
27. On hand supply (DURATION IN DAYS):
27b. N95 respirators
30. Are you able maintain at least a three day
supply of these items?
30c. N95 respirators
>30 days
Yes
27c. Surgical and procedure masks
30e. Surgical and procedure masks
>30 days
Yes
27d. Eye protection including face shields and goggles
30f. Eye protection including face shields and goggles
>30 days
Yes
27e. Single-use gowns
30g. Single-use gowns
>30 days
Yes
27f. Exam gloves (sterile and non-sterile)
30h. Exam gloves
>30 days
Yes
Influenza
33. Total hospitalized patients with laboratory-confirmed
influenza virus infection (Optional)
0
34. Previous day's influenza admissions (laboratoryconfirmed influenza virus infection) (Optional)
0
35. Total hospitalized ICU patients with laboratory-confirmed
influenza virus infection (Optional)
0
Vaccinations
Vaccinations for Personnel
41. Previous week’s COVID-19 vaccination doses administered
to healthcare personnel by your facility (Regardless of series
or single-dose vaccine) (Optional)
42. Current healthcare personnel who have not yet received
any COVID-19 vaccination doses (Optional)
0
45. Total number of current healthcare personnel (Optional)
96
43. Current healthcare personnel who have received the first
dose of COVID-19 vaccination doses (Optional)
110
44. Current healthcare personnel who have received a
completed series of a COVID-19 vaccination or a single-dose
vaccination (Optional)
100
186
Vaccinations for Patients
46. Previous week's number of patients and other nonhealthcare personnel who received the first dose in a multiseries of COVID-19 vaccination doses (Optional)
0
47. Previous week's number of patients who received the
final dose in a series of COVID-19 vaccination doses or the
single-dose vaccine by your facility (Optional)
0
Inactive Federal Data Collection
The below fields have been made inactive for the federal data collection. Hospitals no longer need to report these data elements to the federal government.
Note: State, local, tribal, and territorial (SLTT) partners may have reporting requirements related to or independent of the federal reporting requirements. Facilities are encouraged to work with relevant (SLTT) partners to ensure complete
reporting for all partners.
Staffed Bed Capacity
2a. All hospital beds
Unknown
2b. All adult hospital beds
Unknown
Ventilators
7. Total mechanical ventilators
Unknown
8. Mechanical ventilators in use
Unknown
ED/Overflow
14. ED/overflow
Unknown
15. ED/overflow and ventilated
Unknown
Previous Day's COVID-19 Deaths
16. Previous Day's COVID-19 Deaths
Unknown
Therapeutics
Remdesivir
21. Previous day's Remdesivir used (Optional)
Bamlanivimab (Therapeutic B)
Unknown
22. Current inventory (Optional)
39c. Current inventory on hand (in courses) (Optional)
Unknown
Unknown
39d. Courses used in the last week (Optional)
Unknown
Please note: Bamlanivimab is no longer authorized for
use without accompanying Etesevimab. The value in the
field 39d should be 0. Any doses of Bamlanivimab used
with accompanying Etesevimab should be reported in
field 40b.
Staff
23. Critical staffing shortage today (Y/N) (Optional)
No
25. Staffing shortage details (Optional)
Optional
PPE
26. PPE Supplies
Are your PPE supply items managed (purchased, allocated,
and/or stored) at the facility level or, if you are part of a health
system, at the health system level (or other multiple facility
group)?
27. On hand supply (DURATION IN DAYS):
27a. Ventilator supplies
Unknown
28. On hand supply (INDIVIDUAL
UNITS/”EACHES”) (Optional):
28a. N95 respirators (Optional)
Unknown
29. Are you able to obtain these items?
29a. Ventilator supplies (any supplies excluding medications)
Unknown
Unknown
28b. Other respirators such as PAPRs or elastomerics (Optional)
29b. Ventilator medications
Unknown
Unknown
28c. Surgical and procedure masks (Optional)
29c. N95 Respirators
Unknown
Unknown
28d. Eye protection including face shields and goggles (Optional)
29d. Other respirators such as PAPRs or elastomerics
Unknown
Unknown
28e. Single-use gowns (Optional)
29e. Surgical and procedure masks
Unknown
Unknown
28f. Launderable gowns (Optional)
29f. Eye protection including face shields and goggles
Unknown
Unknown
28g. Exam gloves (single) (Optional)
29g. Single-use gowns
Unknown
Unknown
29h. Exam gloves
Unknown
29i. Are you able to maintain a supply of launderable gowns?
Unknown
30. Are you able maintain at least a three day
supply of these items?
31. Does your facility re-use or extend the
use of PPE? (Optional)
30a. Ventilator supplies (any supplies excluding medications)
31a. Reusable/launderable isolation gowns
Unknown
32. If there are any critical issues, such as supply, staffing,
capacity, or other issues about which you would like to
receive direct contact, please explain here. (Optional)
Unknown
30b Ventilator medications
Optional
31b. PAPRs or elastomerics
Unknown
Unknown
30d. Other respirators such as PAPRs or elastomerics
31c. N95 respirators
Unknown
Unknown
30i. Laboratory - nasal pharyngeal swabs
Unknown
30j. Laboratory - nasal swabs
Unknown
30k. Laboratory - viral transport media
Unknown
Influenza
36. Total hospitalized patients co-infected with BOTH
laboratory-confirmed COVID-19 AND laboratory-confirmed
influenza virus infection (Optional)
Unknown
37. Previous day's influenza deaths (laboratory-confirmed
influenza virus infection) (Optional)
Unknown
38. Previous day's deaths for patients co-infected with both
COVID-19 AND laboratory-confirmed influenza virus
(Optional)
Unknown
| File Type | application/pdf |
| File Modified | 2022-01-05 |
| File Created | 2021-11-29 |