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Congenital Syphilis PoC Testing Supplement
ICR 202607-0920-006 · OMB 0920-1282 · Object 171148600.
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Congenital Syphilis PoC Testing Supplement |
| Author | Evans, Lindsey (CDC/NCHHSTP/DSTDP) |
| Last Modified By | Calc |
| File Modified | 2026-06-26 |
| File Created | 2026-07-24 |
| Conversion State | complete |
Extracted Text
Congenital Syphilis Point-of-Care Testing Supplement — Pe Reporting Period: July 1, 2026 – February 28, 2027 | Due: May 31, 2027 Recipient / Jurisdiction Name Reporting Period July 1, 2026 – February 28, 2027 Report Submission Date SECTION 1 — Procurement (Financial Measures) First, indicate whether your program can distinguish purchases made with supplement funds from purchases made with ot Can your program distinguish purchases made with supplement funds from purchases made with other funds? Table A — Supplement vs. Other Funds (complete if you answered Yes) Item 1a. Syphilis POCTs Purchased with Supplement Funds Purchased with Other Funds 1b. Other syphilis tests (non-POCT, e.g., RPR, TPPA, EIA) 1c. Syphilis treatment medications (e.g., Bicillin L-A) Table B — Total All Funds (complete if you answered No) Item Total Purchased (All Funds) 1a. Syphilis POCTs 1b. Other syphilis tests (non-POCT) 1c. Syphilis treatment medications (e.g., Bicillin L-A) ⚑ Section 1 Data Quality Are there any data quality issues? Describe the issue(s): Steps taken to address: No Additional context for CDC: SECTION 2 — Syphilis Testing Activity (Programmatic Measures) Report ALL syphilis POCTs conducted at your site(s) during the period, regardless of funding source. Data source: testing log Measure Women of Reproductive Age (15–44) Total 2a. POCTs performed — Clinical / STD Clinic 2b. POCTs performed — Prenatal / OB Setting 2c. POCTs performed — Community / Outreach Setting 2d. POCTs performed — Emergency Department 2e. POCTs performed — Partner Services Field Test 2f. POCTs performed — Other (specify venue in Data Source) 2g. TOTAL POCTs Performed (sum of 2a–2f) 0 ⚑ Section 2 Data Quality Are there any data quality issues? 0 Select Describe the issue(s): Steps taken to address: Additional context for CDC: SECTION 3 — POCT Results & Confirmatory Testing Source: LIS or requisition form records. Each reactive POCT should be linked to a confirmatory serologic result where availab Measure 3a. Number of reactive (positive) POCT results 3b. Of reactive POCTs: number with a confirmatory test ordered 3c. Of confirmatory tests ordered: number confirmed positive (true positive) Total Count Women of Reproductive Age (15–44) 3d. Of confirmatory tests ordered: number confirmed negative (false positive POCT) 3e. Of confirmatory tests ordered: number with result pending or unknown 3f. Check: 3c + 3d + 3e should equal 3b 0 ⚑ Section 3 Data Quality Are there any data quality issues? 0 Select Describe the issue(s): Steps taken to address: Additional context for CDC: SECTION 4 — Case Identification & Treatment Outcomes (Women) Source: Disease case records, EHR, or STD surveillance system. Count only cases identified and treated during the period of Measure Count Auto-Calculated Proportion — (reference total) 4a. Women with newly diagnosed syphilis (any stage) 4a-i. Of those: women of reproductive age (15–44) — 4a-ii. Of those: pregnant women — 4b. Women completely and correctly treated for syphilis — 4b-i. Of those: pregnant women completely and correctly treated — ⚑ Section 4 Data Quality Are there any data quality issues? Select Describe the issue(s): Steps taken to address: Additional context for CDC: SECTION 5 — Qualitative Supplement Impact (Required for All Recipients) Responses should be 2–5 sentences each. These questions allow you to describe supplement impact regardless of data trac 5a. How did the supplement funding change or expand your program's syphilis POCT capacity compared to before the su 5b. Were there any barriers to using supplement-purchased POCTs or treatment medications during this period? If so, h 5c. Is there anything else you would like CDC to know about your program's supplement activities or outcomes not capt CDC estimates the average public reporting burden for this collection of information as 3 hours annually, including the time for review collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of informatio including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, At Form Approved OMB Control Number: 09201282 Expiration Date: MM/DD/YYYY e Testing Supplement — Performance Measure Report ruary 28, 2027 | Due: May 31, 2027 (within 90 days of period end) 027 nt funds from purchases made with other funds. Your answer determines which table to complete below. ases made with other funds? sed (All Funds) Yes ACTIVE Total Purchased Data Source Reporting Mechanism 0 e.g., Purchase orders, procurement system… 0 e.g., Lab ordering records, e.g., Exported lab order log; EHR procurement module… summed by test type… 0 e.g., Pharmacy procurement e.g., Pharmacy system records, clinic supply logs… export; specify unit type… Data Source Unit of measure for procured te e.g., Pulled from finance system; filtered by fund code… Reporting Mechanism e.g., All procurement or purchase order records… e.g., Total POCT units procured July 1–Feb 28, all fund sources… e.g., All procurement or lab ordering records… e.g., Total non-POCT syphilis tests procured, all fund sources… e.g., All pharmacy or clinic procurement records… e.g., Total doses/units procured; specify unit type… Unit of measure for procured te unding source. Data source: testing logs, EHR, or disease surveillance system. Pregnant Women Data Source Reporting Mechanism e.g., Clinic EHR, testing log… e.g., Exported from EHR by test type and visit date… Other Notes e.g., Pulled prenatal visit e.g., OB/prenatal clinic EHR, records filtered by POCT LIS… order… e.g., Outreach program log… e.g., Manual tally from outreach activity reports… e.g., ED information system, e.g., ED EHR query by test LIS… order code and date range… e.g., Partner services field test log, EHR, LIS, or DIS activity records… e.g., Matched field test activity records by venue, test type, and date range… e.g., Program-specific tracking system… 0 Auto-calculated from rows above firmatory serologic result where available. Pregnant Women Total Proportion WRA Proportion Pregnant Proportion — (reference total) — (WRA reference total) — (Pregnant reference total) — — — — — — — — — — — — Reporting Mechanism Other Notes 0 tified and treated during the period of performance. -Calculated Proportion — (reference total) Data Source e.g., STD surveillance system, e.g., Queried system for new case registry… female syphilis cases in period… — e.g., Surveillance system filtered by age 15–44… e.g., Applied age filter to 4a query… — e.g., Case records with pregnancy flag… e.g., Applied pregnancy status filter to 4a query… — e.g., EHR treatment record… e.g., Filtered case records for completed treatment regimen… — e.g., Case management records with pregnancy + treatment flags… plement impact regardless of data tracking limitations. e.g., Cross-referenced diagnosed pregnant women with treatment records… CT capacity compared to before the supplement period? medications during this period? If so, how did your program address them? ement activities or outcomes not captured by the measures above? ours annually, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/informa red to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate w Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282) *Use unique identifier provided it of measure for procured tests/medications (e.g., unit, test kit, vial, dose) it of measure for procured tests/medications (e.g., unit, test kit, vial, dose) Data Source Reporting Mechanism e.g., LIS reactive result query… e.g., Filtered LIS by reactive result and test date range… e.g., LIS order records linked to reactive POCT results… e.g., Matched reactive POCT records to follow-up test orders… e.g., Confirmatory serologic result… e.g., Pulled linked confirmatory results; filtered positive… Other Notes e.g., Confirmatory serologic result… e.g., Pulled linked confirmatory results; filtered negative… e.g., LIS pending queue… e.g., Counted orders with no result entered as of report date… Internal consistency check — autocalculated for total, WRA, and pregnant strata and maintaining the data/information needed, and completing and reviewing the ts regarding this burden estimate or any other aspect of this collection of information, ⚑ Data Quality Dashboard Automatically checks entered data for logical inconsistencies and flags potential issues. Review warnings/errors before sub Errors (must fix) Warnings (review) Checks Passed 0 2 15 Section Check Status Severity Header Recipient name entered Warning Warning Header Submission date entered Warning Warning Section 1 Funding distinction selected Pass OK Section 1 Active procurement table has quantities Warning Warning Section 1 DQ If issue flagged, description provided Pass OK Section 2 At least one POCT count entered Warning Warning Section 2 Row 2a subgroups do not exceed total Pass OK Section 2 Row 2b subgroups do not exceed total Pass OK Section 2 Row 2c subgroups do not exceed total Pass OK Section 2 Row 2d subgroups do not exceed total Pass OK Section 2 Row 2e subgroups do not exceed total Pass OK Section 2 Row 2f subgroups do not exceed total Pass OK Section 2 DQ Pass OK Pass OK Pass OK Pass OK Section 3 DQ If issue flagged, description provided 3b confirmatory orders do not exceed 3a reactive POCTs by stratum 3c+3d+3e aligns with 3b by stratum Reactive POCTs do not exceed total POCTs performed by stratum If issue flagged, description provided Pass OK Section 4 4a newly diagnosed women entered Warning Warning Section 4 4a-i and 4a-ii do not exceed 4a Pass OK Section 4 4b treated does not exceed 4a diagnosed 4b-i treated pregnant does not exceed diagnosed pregnant If issue flagged, description provided Pass OK Pass OK Pass OK Section 3 Section 3 Cross-Section Section 4 Section 4 DQ iew warnings/errors before submission. Detail Please enter the jurisdiction or recipient name. Please enter the report submission date. Funding distinction selected: Yes Enter at least one quantity in the active Section 1 table, or leave zero only if accurate. Section 1 DQ response complete All Section 2 venue counts are blank/zero. WRA/pregnant counts are within total for row 2a WRA/pregnant counts are within total for row 2b WRA/pregnant counts are within total for row 2c WRA/pregnant counts are within total for row 2d WRA/pregnant counts are within total for row 2e WRA/pregnant counts are within total for row 2f Section 2 DQ response complete 3b is within 3a for total, WRA, and pregnant strata Confirmatory outcomes align with 3b for all strata 3a is within Section 2 POCT totals for all strata Section 3 DQ response complete No newly diagnosed women entered in 4a. Subgroups are within 4a 4b is within 4a 4b-i is within 4a-ii Section 4 DQ response complete How to resolve Type Complete Report Form cell B4. Header Complete Report Form cell B7. Header Select Yes or No in Report Form cell F11. Section 1 Enter quantities in active Table A or Table B. Section 1 Describe the Section 1 issue in the text field. DQ Enter POCT counts for at least one venue, or verify Warning zero. Correct subgroup counts so each is less than or Pass equal to total. Correct subgroup counts so each is less than or Pass equal to total. Correct subgroup counts so each is less than or Pass equal to total. Correct subgroup counts so each is less than or Pass equal to total. Correct subgroup counts so each is less than or Pass equal to total. Correct subgroup counts so each is less than or Pass equal to total. Describe the Section 2 issue in the text field. Pass Reduce 3b or review 3a for the affected stratum. Correct Section 3 outcome counts by stratum or explain in DQ. Review Section 2 totals or Section 3 reactive counts. Describe the Section 3 issue in the text field. Pass Enter count in 4a, or verify zero. Correct subgroup counts so they are less than or equal to 4a. Correct treatment count or diagnosed count. Correct Section 4 pregnant treatment or diagnosis counts. Describe the Section 4 issue in the text field. Warning Pass Pass Pass Pass Pass Pass Pass