Form Approved
OMB No. 0920-0666
Exp. Date: xx/xx/20xx
www.cdc.gov/nhsn
Denominators for Specialty Care Area (SCA)/Oncology (ONC)
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*required for saving |
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Facility ID: |
*Location Code: |
*Month: |
*Year: |
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Date |
*Number of Patients |
**Number of patients with at least 1 central line (if patient has both, count as Temporary only) |
**Number of patients with a urinary catheter |
**Number of Total patients on a ventilator |
Number of patients on APRV |
Number of Episodes of Mechanical Ventilation |
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Temporary |
Permanent |
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*Totals |
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Patient-days |
Temporary CL-days |
Permanent CL-days |
Urinary catheter-days |
Ventilator-days |
Episodes of Mechanical Ventilation |
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**Conditionally required according to the events indicated in Plan. |
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Label |
_____________ |
_____________ |
_____________ |
_____________ |
_____________ |
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Data |
_____________ |
_____________ |
_____________ |
_____________ |
_____________ |
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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)).
Public reporting burden of this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 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, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666). CDC 57.117, Rev 4, v9.2 |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | 57.117 SCA/ONC Denominator |
Author | Amy Schneider;CDC |
File Modified | 0000-00-00 |
File Created | 2023-12-24 |