Form 57.601 Late Onset Sepsis/ Meningitis Denominator Form: Data Tab

Form Approved

OMB No. 0920-0666

Exp. Date: 12/31/2026

www.cdc.gov/nhsn

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

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 minutes 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 H21-8, Atlanta, GA 30333, ATTN:  PRA (0920-0666).

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