Form 57.135 Late Onset Sepsis/ Meningitis Denominator Form: D

Form

OMB No 0920-0666.

Exp. Date xx/xx/xxxx:

Late Onset Sepsis/ Meningitis Denominator Form: Data Table for

Monthly Electronic Upload

These data will be collected in an aggregate monthly electronic file transfer from the facility to NHSN via Clinical Document Architecture (CDA).

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Table 1. CDA File Descriptors		These data elements will be transmitted with each month’s report.
Variable Name	Description of Variable
orgid	NHSN Facility ID number
location	NHSN location code
month	Event month
year	Event year
createDate	Date the record was created
patID	Patient ID
admitdate	Date Admitted to Facility
transDisExpireDate	Date Admitted or Transferred to Location
dob	Date of Birth
birthWt	Patient weight at birth in grams
gesAge	Gestational Age
gender	Gender
dispositionInfant	Disposition of infant
transDisExpireDate	Disposition Date
comment	Comments
createUserID	The user that created the record
version	Version number of the software under which the data was collected
modifyDate	Date the record was last updated
modifyUserID	The user that last modified record
modifyVersion	Version number of the software under which the data was last updated