Hospitals (excluding Psychiatric and Rehabilitation Hospitals)

Unified Hospital Data Surveillance System (U.S. Healthcare COVID-19 Collection)

0990-0478 U.S. Healthcare COVID-19 Portal _ New Entry - 29Nov21

Hospitals (excluding Psychiatric and Rehabilitation Hospitals)

OMB: 0990-0478

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U.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






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File Created2021-11-29

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